Provider Demographics
NPI:1275744112
Name:ALBRITTON, MARY MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MELISSA
Last Name:ALBRITTON
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 1:2449 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2399
Mailing Address - Country:US
Mailing Address - Phone:318-212-7902
Mailing Address - Fax:318-212-7905
Practice Address - Street 1:2449 HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2399
Practice Address - Country:US
Practice Address - Phone:318-212-7902
Practice Address - Fax:318-212-7905
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200148207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1059650Medicaid
LA4P323OtherMEDICARE PTAN
LARES000Medicare UPIN