Provider Demographics
NPI:1033201835
Name:CULBERTSON, CARY A (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:A
Last Name:CULBERTSON
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 1:200 HENRY CLAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-896-9827
Mailing Address - Fax:504-894-5370
Practice Address - Street 1:2201 VETERANS BLVD
Practice Address - Street 2:STE 300
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-833-7374
Practice Address - Fax:504-833-4818
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL023617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1483770Medicaid