Provider Demographics
NPI:1497177786
Name:ERIC LONSETH, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ERIC LONSETH, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LONSETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-327-5857
Mailing Address - Street 1:4213 TEUTON ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4123
Mailing Address - Country:US
Mailing Address - Phone:504-327-5857
Mailing Address - Fax:504-324-3569
Practice Address - Street 1:4213 TEUTON ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4123
Practice Address - Country:US
Practice Address - Phone:504-327-5857
Practice Address - Fax:504-324-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD026075208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1051667Medicaid
LA1051667Medicaid