Provider Demographics
NPI:1295082162
Name:ROBERT V. BLANCHE M.D. LLC
Entity type:Organization
Organization Name:ROBERT V. BLANCHE M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:BLANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-928-2468
Mailing Address - Street 1:9655 PERKINS RD
Mailing Address - Street 2:C-104
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1533
Mailing Address - Country:US
Mailing Address - Phone:225-928-2468
Mailing Address - Fax:225-928-2498
Practice Address - Street 1:7865 JEFFERSON HWY
Practice Address - Street 2:SUITE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1384
Practice Address - Country:US
Practice Address - Phone:225-928-2468
Practice Address - Fax:225-928-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353086Medicaid
LA50802OtherMEDICARE PTAN
LA1353086Medicaid