Provider Demographics
NPI:1891094603
Name:BLANCHARD, MEAGAN TEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:TEAL
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:CELESTE
Other - Last Name:TEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8415 GOODWOOD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7851
Mailing Address - Country:US
Mailing Address - Phone:225-925-9797
Mailing Address - Fax:225-925-9787
Practice Address - Street 1:8415 GOODWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-925-9797
Practice Address - Fax:225-925-9787
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2160290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2160290Medicaid