Provider Demographics
NPI:1801003132
Name:PALAZZO, MARIA CARMEN (MD PHD MMM)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CARMEN
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:MD PHD MMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5052
Mailing Address - Country:US
Mailing Address - Phone:504-897-6555
Mailing Address - Fax:
Practice Address - Street 1:5718 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5052
Practice Address - Country:US
Practice Address - Phone:504-897-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA166702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1901652Medicaid
LAB63203Medicare UPIN
LA5D716Medicare ID - Type Unspecified