Provider Demographics
NPI:1578510988
Name:MASCHERPA-KERKOW, NATHALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:
Last Name:MASCHERPA-KERKOW
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 1:201. ST. ANN DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-626-1717
Mailing Address - Fax:985-674-2814
Practice Address - Street 1:201 ST. ANN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-626-1717
Practice Address - Fax:985-674-2814
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15591R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1479241Medicaid
4J3D6D347Medicare PIN
LA1479241Medicaid
H53686Medicare UPIN
LAH53686Medicare UPIN