Provider Demographics
NPI:1144414020
Name:DUMLAO, MAE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:M
Last Name:DUMLAO
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 1:1202 S. TYLER STREET
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2330
Mailing Address - Country:US
Mailing Address - Phone:985-898-4194
Mailing Address - Fax:985-898-4164
Practice Address - Street 1:1202 S. TYLER STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2330
Practice Address - Country:US
Practice Address - Phone:985-898-4194
Practice Address - Fax:985-898-4164
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37211207R00000X
LA205110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ320528Medicaid
LA4Q812Medicare PIN
AZ117545Medicare PIN