Provider Demographics
NPI:1548585672
Name:MATHEWS, EVA MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:MARINA
Last Name:MATHEWS
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 1:5131 ODONOVAN DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4782
Mailing Address - Country:US
Mailing Address - Phone:225-374-0400
Mailing Address - Fax:225-374-0430
Practice Address - Street 1:5131 ODONOVAN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4782
Practice Address - Country:US
Practice Address - Phone:225-374-0400
Practice Address - Fax:225-374-0430
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2069682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07609864Medicaid
LA2369041Medicaid
360480YJA2Medicare PIN