Provider Demographics
NPI:1124075346
Name:JACKSON-TRICHE, MAGA E (MD)
Entity type:Individual
Prefix:DR
First Name:MAGA
Middle Name:E
Last Name:JACKSON-TRICHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGA
Other - Middle Name:E
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1555 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3701
Mailing Address - Country:US
Mailing Address - Phone:504-589-5913
Mailing Address - Fax:504-589-5211
Practice Address - Street 1:1555 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3701
Practice Address - Country:US
Practice Address - Phone:504-589-5913
Practice Address - Fax:504-589-5211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA304012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry