Provider Demographics
NPI:1205006111
Name:ROY, MELISSA HAGGERTY (MD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:HAGGERTY
Last Name:ROY
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 1:7777 HENNESSY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4363
Mailing Address - Country:US
Mailing Address - Phone:225-767-6700
Mailing Address - Fax:225-767-6721
Practice Address - Street 1:7777 HENNESSY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4363
Practice Address - Country:US
Practice Address - Phone:225-767-6700
Practice Address - Fax:225-767-6721
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2016892080P0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508276Medicaid