Healthcare Provider Details

I. General information

NPI: 1750905378
Provider Name (Legal Business Name): SMRITHI KRISHNAMOHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date: 01/18/2022
Reactivation Date: 08/15/2023

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

1325 ANNUNCIATION ST APT 212
NEW ORLEANS LA
70130-4065
US

V. Phone/Fax

Practice location:
  • Phone: 504-894-5113
  • Fax: 877-406-9645
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number354361
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: