Provider Demographics
NPI:1235175696
Name:CRITTELL, MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:CRITTELL
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 1:1811 E BERT KOUNS INDUSTRIAL LOOP STE 140
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5741
Mailing Address - Country:US
Mailing Address - Phone:318-212-3900
Mailing Address - Fax:318-212-3945
Practice Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP STE 140
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5741
Practice Address - Country:US
Practice Address - Phone:318-212-3900
Practice Address - Fax:318-212-3945
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15185R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1461075Medicaid