Healthcare Provider Details

I. General information

NPI: 1235113770
Provider Name (Legal Business Name): INGRID K ROSKOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/29/2026
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 ROBERT BLVD. SUITE 220
SLIDELL LA
70458
US

IV. Provider business mailing address

1150 ROBERT BLVD. SUITE 220
SLIDELL LA
70458
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-4848
  • Fax: 985-781-4850
Mailing address:
  • Phone: 985-781-4848
  • Fax: 985-781-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number14651R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14651R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: