Individual
MAMATHA ANANTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
433 PLAZA ST STE 1A, BOGALUSA, LA 70427-3729
(985) 730-6970
(985) 730-6398
Mailing address
433 PLAZA ST, BOGALUSA, LA 70427-3729
(985) 730-6970
(985) 730-6398
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MD11747R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1797103
—
LA
Enumeration date
09/19/2005
Last updated
10/25/2019
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