Provider Demographics
NPI:1487032876
Name:MORGAN, MARK (RD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 MORALES ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2447
Mailing Address - Country:US
Mailing Address - Phone:414-405-4488
Mailing Address - Fax:
Practice Address - Street 1:4401 MORALES ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2447
Practice Address - Country:US
Practice Address - Phone:414-405-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered