Provider Demographics
NPI:1811002744
Name:SALEME, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SALEME
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 1:401 YOUNGSVILLE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5173
Mailing Address - Country:US
Mailing Address - Phone:337-330-0031
Mailing Address - Fax:337-365-3050
Practice Address - Street 1:6100 CAMERON STREET
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-289-6770
Practice Address - Fax:337-289-6718
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025472208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576522Medicaid
MS$$$$$$$$$COtherBCBS
MS$$$$$$$$$BOtherBCBS
MS370000247Medicare ID - Type Unspecified
MS$$$$$$$$$AOtherBCBS
MS00125850Medicaid