Provider Demographics
NPI:1568404390
Name:JANCICH, SOPHY ANN (MD)
Entity Type:Individual
Prefix:
First Name:SOPHY
Middle Name:ANN
Last Name:JANCICH
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 1:120 OCHSNER BLVD. SUITE 310
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-595-8014
Mailing Address - Fax:504-595-8115
Practice Address - Street 1:120 OCHSNER BLVD STE 310
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-595-8014
Practice Address - Fax:504-595-8115
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023710207RH0003X
LAMD.023710207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01061634AOtherMEDICAL LICENSE #
WAMD00046564OtherMEDICAL LICENSE #
LA1484571Medicaid
MS04286541Medicaid
AZ35577OtherMEDICAL LICENSE #
LA1484571Medicaid
MS04286541Medicaid
LA4M4517061Medicare PIN