Provider Demographics
NPI:1710021357
Name:APPLEWHITE, MARY LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY LOU
Middle Name:
Last Name:APPLEWHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5406
Mailing Address - Country:US
Mailing Address - Phone:504-889-9522
Mailing Address - Fax:504-889-9577
Practice Address - Street 1:3100 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5406
Practice Address - Country:US
Practice Address - Phone:504-889-9522
Practice Address - Fax:504-889-9577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL007589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB62550Medicare UPIN