Provider Demographics
NPI:1619966900
Name:ELSEA, DEANNA S (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:S
Last Name:ELSEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:SILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:13100 RIVER RD STE 120
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-5216
Practice Address - Country:US
Practice Address - Phone:985-764-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031550207R00000X
LA303786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99227Medicare UPIN