Provider Demographics
NPI:1336136563
Name:MARCANTEL, KARA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:BETH
Last Name:MARCANTEL
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:PO BOX 52046
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2046
Mailing Address - Country:US
Mailing Address - Phone:337-849-3032
Mailing Address - Fax:
Practice Address - Street 1:109 MOSSY OAKS
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2262
Practice Address - Country:US
Practice Address - Phone:337-849-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0237672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484962Medicaid
LAH78790Medicare UPIN
LA1484962Medicaid