Provider Demographics
NPI:1629041116
Name:BLACKMAN, HARRIS MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:MARSHALL
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 EDENBORN AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1522
Mailing Address - Country:US
Mailing Address - Phone:504-456-2871
Mailing Address - Fax:504-349-6555
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE N-401
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-347-2141
Practice Address - Fax:504-349-6555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308340Medicaid
LA50349Medicare ID - Type UnspecifiedMEDICARE PROV. #
LA1308340Medicaid