Provider Demographics
NPI:1760861348
Name:SKALAK, MARADITH LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARADITH
Middle Name:LYNN
Last Name:SKALAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARADITH
Other - Middle Name:LYNN
Other - Last Name:NOONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4740 S I 10 SERVICE RD W STE 200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1244
Mailing Address - Country:US
Mailing Address - Phone:951-315-8025
Mailing Address - Fax:
Practice Address - Street 1:4700 S I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1210
Practice Address - Country:US
Practice Address - Phone:504-780-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3284602080N0001X
OH35.1336012080N0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty