Provider Demographics
NPI:1033141056
Name:PATIN, CAROL M (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:PATIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 PICARDY AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3670
Mailing Address - Country:US
Mailing Address - Phone:225-763-4990
Mailing Address - Fax:225-763-4987
Practice Address - Street 1:8595 PICARDY AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3670
Practice Address - Country:US
Practice Address - Phone:225-763-4990
Practice Address - Fax:225-763-4987
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019120207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1901997Medicaid
LA1901997Medicaid
LA5N135D322Medicare PIN