Basic Information
| Provider Information | |||||||||
| NPI: | 1700014818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADDOX | ||||||||
| FirstName: | SUMA | ||||||||
| MiddleName: | SANGISETTY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W ESPLANADE AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044648588 | ||||||||
| FaxNumber: | 5048427512 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W ESPLANADE AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044648588 | ||||||||
| FaxNumber: | 5048427512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD.206967 | LA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.