Provider Demographics
NPI:1427035278
Name:MARAGANORE, DEMETRIUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIUS
Middle Name:M
Last Name:MARAGANORE
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 1:131 S ROBERTSON ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 JUDGE TANNER BLVD STE 402
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7505
Practice Address - Country:US
Practice Address - Phone:985-951-3222
Practice Address - Fax:985-951-3223
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1371562084N0400X
MN301502084N0400X
LA3222962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN254825900Medicaid
FL100380700Medicaid
MN254825900Medicaid
MN130000324Medicare ID - Type Unspecified