Provider Demographics
NPI:1801114624
Name:LAHOUD, JACQUELYN SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:SUZANNE
Last Name:LAHOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:SUZANNE
Other - Last Name:BERTELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7515 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2409
Mailing Address - Country:US
Mailing Address - Phone:718-234-8111
Mailing Address - Fax:718-234-5377
Practice Address - Street 1:7515 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2409
Practice Address - Country:US
Practice Address - Phone:718-234-8111
Practice Address - Fax:718-234-5379
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272160207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine