Provider Demographics
NPI:1912902867
Name:DIXIT, MADHURI DEEPAK (MD)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:DEEPAK
Last Name:DIXIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHURI
Other - Middle Name:MADHAVRAO
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:843 MILLING AVE
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4442
Mailing Address - Country:US
Mailing Address - Phone:985-785-5852
Mailing Address - Fax:985-785-5811
Practice Address - Street 1:1340 14TH ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2944
Practice Address - Country:US
Practice Address - Phone:985-601-0410
Practice Address - Fax:985-649-8703
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10981R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1649937Medicaid
LA5U823Medicare ID - Type Unspecified
LA1649937Medicaid