Provider Demographics
NPI:1619929080
Name:BRANCH, LIONEL ANDREW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:ANDREW
Last Name:BRANCH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1542 TULANE AVE RM 763
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112
Mailing Address - Country:US
Mailing Address - Phone:504-568-4080
Mailing Address - Fax:225-644-4909
Practice Address - Street 1:1400 POYDRAS STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-258-1086
Practice Address - Fax:225-644-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA0233132084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1498831Medicaid
LA1498831Medicaid
H24979Medicare UPIN
LAH24979Medicare UPIN