1205865532 NPI number — LAWANDA E LAMAR-BELLAMY MD

Table of content: LAWANDA E LAMAR-BELLAMY MD (NPI 1205865532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205865532 NPI number — LAWANDA E LAMAR-BELLAMY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMAR-BELLAMY
Provider First Name:
LAWANDA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205865532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 CROWLEY RAYNE HWY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CROWLEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70526-8210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-839-6720
Provider Business Mailing Address Fax Number:
716-839-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 CROWLEY RAYNE HWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CROWLEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70526-8210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-839-6720
Provider Business Practice Location Address Fax Number:
716-839-6740
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD205165 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080627000062 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528626005 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02772530 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205865532 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080627000064 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1213454 . This is a "IHA" identifier . This identifiers is of the category "OTHER".




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