Provider Demographics
NPI:1508964990
Name:BISHOP, LAURIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:225-930-7524
Practice Address - Street 1:100 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-646-5075
Practice Address - Fax:225-930-7524
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05630R2085R0202X
LAMD.05630R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1342181Medicaid
MO00112168Medicaid
MO00112168Medicaid
LA5M826Medicare ID - Type UnspecifiedMEDICARE IND NUM
LAB62042Medicare UPIN
LA5M8266629Medicare PIN