Provider Demographics
NPI:1477584563
Name:STAUDINGER, EDWARD BALLOU (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BALLOU
Last Name:STAUDINGER
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 1:2820 NAPOLEON AVE
Mailing Address - Street 2:640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6969
Mailing Address - Country:US
Mailing Address - Phone:504-897-1327
Mailing Address - Fax:504-897-1364
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:640
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-897-1327
Practice Address - Fax:504-897-1364
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358673Medicaid
LAB62004Medicare UPIN
LA5M771Medicare ID - Type UnspecifiedLA MEDICARE