Provider Demographics
NPI:1316036643
Name:MCGINNESS, CLIFTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
Last Name:MCGINNESS
Suffix:
Gender:M
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:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1536
Mailing Address - Country:US
Mailing Address - Phone:985-626-6996
Mailing Address - Fax:985-626-6995
Practice Address - Street 1:3800 HOUMA BLVD STE 325
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4184
Practice Address - Country:US
Practice Address - Phone:985-626-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016106208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358851Medicaid
LAB63038Medicare UPIN
LA51406Medicare ID - Type Unspecified