Provider Demographics
NPI:1558569491
Name:MARY LOU APPLEWHITE, MD, PC
Entity Type:Organization
Organization Name:MARY LOU APPLEWHITE, MD, PC
Other - Org Name:APPLEWHITE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-889-9522
Mailing Address - Street 1:3100 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5406
Mailing Address - Country:US
Mailing Address - Phone:504-889-9522
Mailing Address - Fax:504-889-9577
Practice Address - Street 1:3100 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5406
Practice Address - Country:US
Practice Address - Phone:504-889-9522
Practice Address - Fax:504-889-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CY80Medicare PIN