Provider Demographics
NPI:1932189016
Name:SMITH, SUMATHI SIVA (MD)
Entity Type:Individual
Prefix:
First Name:SUMATHI
Middle Name:SIVA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMATHI
Other - Middle Name:
Other - Last Name:SIVASUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:504-679-9928
Practice Address - Street 1:1120 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2068
Practice Address - Country:US
Practice Address - Phone:985-639-3777
Practice Address - Fax:985-639-3708
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11896R207RH0003X
LAMD11896R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1690384Medicaid
MS04554341Medicaid
MS04554341Medicaid
LA5Y224F818Medicare PIN
LA5Y2246629Medicare PIN
LA5Y224CB84Medicare PIN
G42318Medicare UPIN