Provider Demographics
NPI:1083636880
Name:MONCADA, LAINIE VAN VOAST (MD)
Entity Type:Individual
Prefix:
First Name:LAINIE
Middle Name:VAN VOAST
Last Name:MONCADA
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 1:501 W SAINT MARY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4665
Mailing Address - Country:US
Mailing Address - Phone:337-470-4500
Mailing Address - Fax:
Practice Address - Street 1:501 W SAINT MARY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4665
Practice Address - Country:US
Practice Address - Phone:337-470-4500
Practice Address - Fax:337-470-4515
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024343207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1570371Medicaid
H70329Medicare UPIN
4F831Medicare ID - Type Unspecified