Provider Demographics
NPI:1588625040
Name:MELANCON, CAROL BAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BAKER
Last Name:MELANCON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5253 DIJON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4312
Mailing Address - Country:US
Mailing Address - Phone:225-768-1611
Mailing Address - Fax:225-768-1615
Practice Address - Street 1:5253 DIJON DR
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4312
Practice Address - Country:US
Practice Address - Phone:225-768-1611
Practice Address - Fax:225-768-1615
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11155R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1666823Medicaid
G14670Medicare UPIN
5W459Medicare ID - Type Unspecified