Provider Demographics
NPI:1609918424
Name:NORTHSHORE HOSPITALISTS, LLC
Entity Type:Organization
Organization Name:NORTHSHORE HOSPITALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVALLE-MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-781-8565
Mailing Address - Street 1:85 WHISPERWOOD BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 WHISPERWOOD BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1136
Practice Address - Country:US
Practice Address - Phone:985-781-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CH11Medicare ID - Type Unspecified