Provider Demographics
NPI:1477764892
Name:SMITH, RITA GHOSH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:GHOSH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:GHOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:821 ELLIOTT ST
Mailing Address - Street 2:LSUHSC DEPARTMENT OF FAMILY PRACTICE
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-7732
Mailing Address - Country:US
Mailing Address - Phone:318-675-7737
Mailing Address - Fax:318-675-5666
Practice Address - Street 1:821 ELLIOTT ST
Practice Address - Street 2:LSUHSC DEPARTMENT OF FAMILY PRACTICE
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-7732
Practice Address - Country:US
Practice Address - Phone:318-675-7737
Practice Address - Fax:318-675-5666
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD203187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1078093Medicaid