1144354473 NPI number — DR. GERALDINE ALBA ST. GERMAIN MD

Table of content: DR. GERALDINE ALBA ST. GERMAIN MD (NPI 1144354473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144354473 NPI number — DR. GERALDINE ALBA ST. GERMAIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST. GERMAIN
Provider First Name:
GERALDINE
Provider Middle Name:
ALBA
Provider Name Prefix Text:
DR.
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:
1144354473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4228 HOUMA BLVD
Provider Second Line Business Mailing Address:
STE 410
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-883-3770
Provider Business Mailing Address Fax Number:
504-883-3711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 HOUMA BLVD
Provider Second Line Business Practice Location Address:
STE 410
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-883-3770
Provider Business Practice Location Address Fax Number:
504-883-3711
Provider Enumeration Date:
03/16/2007

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: 207V00000X , with the licence number:  2008-01137 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 40544 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 203462 , 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: 7809332 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3000130 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4154127 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7012962 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09377061 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5910195 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00411147 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 84617 . This is a "BCBS AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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