Provider Demographics
NPI:1609855436
Name:FOUNTAIN, HELEN VIDALI (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:VIDALI
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:HELEN
Other - Last Name:O'DONAVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2700 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6914
Practice Address - Country:US
Practice Address - Phone:504-842-3650
Practice Address - Fax:504-894-2086
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD550522080N0001X
NC2004010592080N0001X
IN01043471A2080N0001X
WI3000-3202080N0001X
LA3107442080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13705OtherBCBS
NC8913705Medicaid
FL43713OtherBCBS