Provider Demographics
NPI:1649435512
Name:MARY ELIZABETH CHRISTIAN MD, PMC
Entity type:Organization
Organization Name:MARY ELIZABETH CHRISTIAN MD, PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-216-1118
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5127
Mailing Address - Country:US
Mailing Address - Phone:225-216-1118
Mailing Address - Fax:225-216-1119
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5127
Practice Address - Country:US
Practice Address - Phone:225-216-1118
Practice Address - Fax:225-216-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1149861Medicaid
LAF61972Medicare UPIN