Provider Demographics
NPI:1376542233
Name:KLAR, ANGELLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELLE
Middle Name:L
Last Name:KLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELLE
Other - Middle Name:L
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS242902080N0001X
LA0253222080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00339060Medicaid
LA1574813Medicaid
MS510694YJ5DMedicare PIN
LA1574813Medicaid