Provider Demographics
NPI:1710938113
Name:CARTER, SUSAN P (LOTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:CARTER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LESLIE
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:270 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2910
Mailing Address - Country:US
Mailing Address - Phone:985-626-8474
Mailing Address - Fax:
Practice Address - Street 1:1740 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3110
Practice Address - Country:US
Practice Address - Phone:985-727-0097
Practice Address - Fax:985-727-5006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H7926CR79Medicare ID - Type UnspecifiedOT