Healthcare Provider Details

I. General information

NPI: 1932189016
Provider Name (Legal Business Name): SUMATHI SIVA SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMATHI SIVASUBRAMANIAM MD

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 ROBERT BLVD
SLIDELL LA
70458-2068
US

IV. Provider business mailing address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax: 985-639-3708
Mailing address:
  • Phone: 504-842-4000
  • Fax: 504-679-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number11896R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD11896R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: