1871763987 NPI number — MRS. VERONICA GARIBALDI LEWIS M.D.

Table of content: MRS. VERONICA GARIBALDI LEWIS M.D. (NPI 1871763987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871763987 NPI number — MRS. VERONICA GARIBALDI LEWIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
VERONICA
Provider Middle Name:
GARIBALDI
Provider Name Prefix Text:
MRS.
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:
GARIBALDI
Provider Other First Name:
VERONICA
Provider Other Middle Name:
AGNES
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871763987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 FRANKLIN AVE STE A2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70122-5716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-226-5739
Provider Business Mailing Address Fax Number:
504-322-2695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 FRANKLIN AVE STE A2
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:
70122-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-226-5739
Provider Business Practice Location Address Fax Number:
504-322-2695
Provider Enumeration Date:
03/04/2008

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:  68583 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 203111 , 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: 003129395A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508268 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203111 . This is a "STATE LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 68583 . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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