Provider Demographics
NPI:1952453854
Name:BERMUDEZ, MARCELITA A (MD)
Entity Type:Individual
Prefix:
First Name:MARCELITA
Middle Name:A
Last Name:BERMUDEZ
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 1:9751 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4942
Mailing Address - Country:US
Mailing Address - Phone:225-923-1315
Mailing Address - Fax:225-634-0229
Practice Address - Street 1:4502 HWY 951
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:LA
Practice Address - Zip Code:70748
Practice Address - Country:US
Practice Address - Phone:225-634-0491
Practice Address - Fax:225-634-0229
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA138642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1953140Medicaid
LA52644Medicare ID - Type Unspecified
LA1953140Medicaid