Provider Demographics
NPI:1518076439
Name:FERVIL, MARIE YOLENE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:YOLENE
Last Name:FERVIL
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 1:1101 MEDICAL CENTER BLVD.
Mailing Address - Street 2:HOSPITALIST DEPARTMENT
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1656
Mailing Address - Fax:504-349-1933
Practice Address - Street 1:1101 MEDICAL CENTER BLVD.
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1656
Practice Address - Fax:504-349-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28282171W00000X
GA055219208M00000X
LAMD.206661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171W00000XOther Service ProvidersContractor
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52038519002OtherBCBS-TMC
AL129228Medicaid
P00992327OtherRR MEDICARE
SC282820Medicaid
AL130433Medicaid
GA581719867 002OtherBCBS-AMB
GA003106224AMedicaid
GA52038519 003OtherBCBS-DH
GA003106224BMedicaid
SCH698517061Medicare ID - Type Unspecified
GA52038519002OtherBCBS-TMC
P00992327OtherRR MEDICARE