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NPI Code Detail

MEDICARE: DR. KASIMU SENGHOR MOODY M.D.

MEDICARE: DR. KASIMU SENGHOR MOODY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician14802RLA
2207P00000XEmergency Medicine PhysicianMD-55687IA

General Provider Information

NPI Number : 1245275536
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KASIMU SENGHOR MOODY M.D.
Provider Business Mailing Address
First Line : 111 GATEWAY DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-7689
Country : US
Telephone Number : 337-273-2588
Fax Number :
Provider Business Practice Location Address
First Line : 73153 MILITARY RD
Second Line :
City : COVINGTON
State : LA
Zip : 70435-6054
Country : US
Telephone Number : 985-626-6133
Fax Number : 985-626-6136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 12/22/2025

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