Provider Demographics
NPI:1891985362
Name:BAUR, JENNIFER PELLEGRIN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PELLEGRIN
Last Name:BAUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:PELLEGRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD
Mailing Address - Street 2:STE 410
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3021
Mailing Address - Country:US
Mailing Address - Phone:504-883-3770
Mailing Address - Fax:504-883-3711
Practice Address - Street 1:4228 HOUMA BLVD.
Practice Address - Street 2:SUITE 410
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-883-3770
Practice Address - Fax:504-883-3711
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1006670Medicaid