Provider Demographics
NPI:1922049071
Name:PEARSON, AMANDA W (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:W
Last Name:PEARSON
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 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5126
Mailing Address - Country:US
Mailing Address - Phone:225-201-2000
Mailing Address - Fax:225-201-2110
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5126
Practice Address - Country:US
Practice Address - Phone:225-201-2000
Practice Address - Fax:225-201-2110
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202076207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187798Medicaid
MS512G700003OtherUP MEDICARE GROUP PROV#
MS08103071OtherUP MEDICAID GROUP PROV#
LAP00860587OtherRAILROAD MEDICARE
MS03851721Medicaid
MS512I160001OtherMEDICARE PTAN
MSP00462300OtherUP RR MEDICARE INDV.
MSDG7781OtherUP GROUP RR MCARE
MS512I160001OtherMEDICARE PTAN
LA1187798Medicaid
LAP00860587OtherRAILROAD MEDICARE