Provider Demographics
NPI:1225246291
Name:HOLMAN, STACEY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEIGH
Last Name:HOLMAN
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 1:1542 TULANE AVE RM 520
Mailing Address - Street 2:DEPARTMENT OF OBGYN
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-4850
Mailing Address - Fax:504-568-5140
Practice Address - Street 1:3700 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4637
Practice Address - Country:US
Practice Address - Phone:504-412-1520
Practice Address - Fax:504-412-1534
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200285207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1074420Medicaid
LA4N219F669Medicare PIN
LA4N219Medicare PIN