Provider Demographics
NPI:1558412940
Name:BLOCH, TED III (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:BLOCH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:504-897-7939
Mailing Address - Fax:504-897-7949
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:SUITE 211
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3500
Practice Address - Country:US
Practice Address - Phone:504-897-7939
Practice Address - Fax:504-897-7949
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0205472084P0800X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF83542Medicare UPIN
LA5U449Medicare ID - Type Unspecified