Provider Demographics
NPI:1033584065
Name:MAUREEN A OLIVIER M.D.
Entity Type:Organization
Organization Name:MAUREEN A OLIVIER M.D.
Other - Org Name:OLIVIER DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-474-1386
Mailing Address - Street 1:4150 NELSON RD
Mailing Address - Street 2:BUILDING E SUITE 1
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4140
Mailing Address - Country:US
Mailing Address - Phone:337-474-1386
Mailing Address - Fax:
Practice Address - Street 1:4150 NELSON RD
Practice Address - Street 2:BUILDING E SUITE 1
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4140
Practice Address - Country:US
Practice Address - Phone:337-474-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA54443OtherMEDICARE P-TAN
LA1300586Medicaid
LA015309OtherSTATE LICENSE
LAP00718528Medicare PIN
LA1300586Medicaid
LA544437460Medicare PIN