Provider Demographics
NPI:1053319780
Name:COREIL, VIRGINIA B (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:B
Last Name:COREIL
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-989-5061
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY BLDG 12
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-470-3150
Practice Address - Fax:337-470-3161
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12562R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1540382Medicaid
LA1540382Medicaid
G68275Medicare UPIN