Provider Demographics
NPI:1104836790
Name:OVELLA, SUSAN F (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:F
Last Name:OVELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:985-730-7195
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:728 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2318
Practice Address - Country:US
Practice Address - Phone:225-765-5777
Practice Address - Fax:225-765-6642
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23081208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1491110Medicaid
MS08687793Medicaid
LAP00148566OtherMEDICARE RAILROAD ID
MS08687793Medicaid
LA1491110Medicaid