Provider Demographics
NPI:1053581710
Name:SISCO, LESLIE ELAINE (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELAINE
Last Name:SISCO
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 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:OCHSNER MEDICAL CENTER
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2272
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:504-842-6784
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3970
Practice Address - Fax:504-842-6784
Is Sole Proprietor?:No
Enumeration Date:2008-03-08
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200770207XS0106X
LA200770207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06474574Medicaid
LA1074713Medicaid
MS06474574Medicaid