Healthcare Provider Details

I. General information

NPI: 1700014818
Provider Name (Legal Business Name): SUMA SANGISETTY MADDOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 MAGAZINE ST
NEW ORLEANS LA
70130-4220
US

IV. Provider business mailing address

1244 MAGAZINE ST
NEW ORLEANS LA
70130-4220
US

V. Phone/Fax

Practice location:
  • Phone: 504-249-3805
  • Fax: 504-249-3806
Mailing address:
  • Phone: 504-249-3805
  • Fax: 504-249-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD.206967
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: