Provider Demographics
NPI:1740271097
Name:DUTHU, ANGELA S (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:DUTHU
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 1:3020 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4155
Mailing Address - Country:US
Mailing Address - Phone:985-726-0800
Mailing Address - Fax:985-726-0803
Practice Address - Street 1:3020 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4155
Practice Address - Country:US
Practice Address - Phone:985-726-0800
Practice Address - Fax:985-726-0803
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1333956Medicaid