Provider Demographics
NPI:1932104486
Name:ALBRECHT, CHRISTINE DE ALENCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DE ALENCAR
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:ALBRECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:855 BELANGER ST
Mailing Address - Street 2:STE 209
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4463
Mailing Address - Country:US
Mailing Address - Phone:985-873-0112
Mailing Address - Fax:985-857-8624
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:STE 209
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-873-0112
Practice Address - Fax:985-857-8624
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11547R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1680001Medicaid
LAG24683Medicare UPIN
LA5W753Medicare ID - Type Unspecified