Provider Demographics
NPI:1184970220
Name:DOSS, MALLIKA (MD)
Entity type:Individual
Prefix:
First Name:MALLIKA
Middle Name:
Last Name:DOSS
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 1:4224 HOUMA BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2980
Mailing Address - Country:US
Mailing Address - Phone:504-456-2691
Mailing Address - Fax:
Practice Address - Street 1:4224 HOUMA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2980
Practice Address - Country:US
Practice Address - Phone:504-456-2691
Practice Address - Fax:504-456-2692
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309345207WX0107X, 207W00000X
PAMD458356207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology