1770724767 NPI number — ANGELLE MARIE GELVIN M.D.

Table of content: ANGELLE MARIE GELVIN M.D. (NPI 1770724767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770724767 NPI number — ANGELLE MARIE GELVIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELVIN
Provider First Name:
ANGELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1770724767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 PRYTANIA ST
Provider Second Line Business Mailing Address:
SUITE 35
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70115-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-897-8315
Provider Business Mailing Address Fax Number:
504-891-9893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9801 LAKE FOREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70127-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-246-1452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2009

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: 208600000X , with the licence number:  MD.204863 , 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: 1968412 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com