Provider Demographics
NPI:1386648822
Name:DERY, MARKALAIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARKALAIN
Middle Name:
Last Name:DERY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 JULIA ST APT 209
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-3600
Mailing Address - Country:US
Mailing Address - Phone:504-343-4914
Mailing Address - Fax:
Practice Address - Street 1:3225 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6203
Practice Address - Country:US
Practice Address - Phone:504-821-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO 000055207RI0200X
LADO.000055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1020371Medicaid
LA4K756Medicare PIN