Provider Demographics
NPI:1447219803
Name:SMITH, RAELANDA (MD)
Entity Type:Individual
Prefix:
First Name:RAELANDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-1411
Mailing Address - Country:US
Mailing Address - Phone:601-749-5812
Mailing Address - Fax:601-749-5812
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:601-749-5812
Practice Address - Fax:601-749-5812
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030268907Medicaid
TX8M8692OtherBCBS
TX030268907Medicaid
TXH38274Medicare UPIN