Provider Demographics
NPI:1467502047
Name:BACCHUS, MARCEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:
Last Name:BACCHUS
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 1:3600 PRYTANIA STREET
Mailing Address - Street 2:SUITE 72
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3672
Mailing Address - Country:US
Mailing Address - Phone:504-897-8315
Mailing Address - Fax:504-891-9862
Practice Address - Street 1:1520 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2334
Practice Address - Country:US
Practice Address - Phone:504-944-0101
Practice Address - Fax:504-944-6333
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05967R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330787Medicaid
LA5M920D516Medicare PIN
LA160042412Medicare PIN
B89281Medicare UPIN