1639249824 NPI number — MR. MARC DE SOLER M.D.

Table of content: MELISSA LAVENDER (NPI 1578295028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639249824 NPI number — MR. MARC DE SOLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE SOLER
Provider First Name:
MARC
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1639249824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71210-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-966-4917
Provider Business Mailing Address Fax Number:
318-966-4916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 JACKSON ST 4TH FLOOR NICU
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-7407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-327-4917
Provider Business Practice Location Address Fax Number:
318-327-4916
Provider Enumeration Date:
11/08/2006

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: 2080N0001X , with the licence number:  08063R , 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: 142665001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1382141 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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