Provider Demographics
NPI:1245448208
Name:TALBOT, AMANDA LAVIGNE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAVIGNE
Last Name:TALBOT
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4242 HIGHWAY 19 STE C
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3981
Practice Address - Country:US
Practice Address - Phone:225-654-6140
Practice Address - Fax:225-654-6122
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1170771Medicaid
LA4M805D279Medicare PIN