1699821298 NPI number — MISTY MANUEL NORMAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699821298 NPI number — MISTY MANUEL NORMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORMAN
Provider First Name:
MISTY
Provider Middle Name:
MANUEL
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:
MANUEL
Provider Other First Name:
MISTY
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699821298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8230 SUMMA AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809-3465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-757-0552
Provider Business Mailing Address Fax Number:
225-763-9997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WOMANS WAY
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIOLOGY, WOMEN'S HOSPITAL
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70817-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-8267
Provider Business Practice Location Address Fax Number:
225-924-8242
Provider Enumeration Date:
01/26/2007

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: 2085R0202X , with the licence number:  239109 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 025987 , 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: 1050202 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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