Provider Demographics
NPI:1700189396
Name:CHERI LEBLANC, MD, LLC
Entity Type:Organization
Organization Name:CHERI LEBLANC, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-756-5305
Mailing Address - Street 1:15165 S HARRELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2910
Mailing Address - Country:US
Mailing Address - Phone:225-756-5305
Mailing Address - Fax:225-756-5307
Practice Address - Street 1:15165 S HARRELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2910
Practice Address - Country:US
Practice Address - Phone:225-756-5305
Practice Address - Fax:225-756-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11032 R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG20091Medicare UPIN
LA5W535Medicare PIN