Provider Demographics
NPI:1053325217
Name:HADDAD, HEATHER L (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HADDAD
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:PO BOX 55309
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-757-0552
Practice Address - Fax:225-763-9997
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL281542085R0202X
LA2033032085R0202X
NC2006-007612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009943043Medicaid
AL009943061Medicaid
AL051541150OtherBLUE CROSS
AL051541153OtherBLUE CROSS
AL009943044Medicaid
AL051541155OtherBLUE CROSS
LA1036927Medicaid
AL009943059Medicaid
AL009943146Medicaid
AL051541151OtherBLUE CROSS
AL051541149OtherBLUE CROSS
ALI63242Medicare UPIN
AL009943061Medicaid
AL051541155OtherBLUE CROSS
AL009943146Medicaid