Provider Demographics
NPI:1528055340
Name:CALDWELL, SUSAN PENTON (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PENTON
Last Name:CALDWELL
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 1:1100 POYDRAS ST
Mailing Address - Street 2:2500 ENERGY CENTRE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70163-2500
Mailing Address - Country:US
Mailing Address - Phone:504-527-9953
Mailing Address - Fax:504-527-9950
Practice Address - Street 1:4315 HOUMA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2941
Practice Address - Country:US
Practice Address - Phone:504-503-5123
Practice Address - Fax:504-503-5129
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025102208000000X
LAMD025102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420328Medicaid
MS02980540Medicaid
I24288Medicare UPIN
LA4J3107061Medicare PIN
LAI24288Medicare UPIN
MS02980540Medicaid