Provider Demographics
NPI:1770611576
Name:MARY, MIGNONNE C (MD)
Entity type:Individual
Prefix:DR
First Name:MIGNONNE
Middle Name:C
Last Name:MARY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1224 SAINT CHARLES AVE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4334
Mailing Address - Country:US
Mailing Address - Phone:504-301-1670
Mailing Address - Fax:504-309-4413
Practice Address - Street 1:1224 SAINT CHARLES AVE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4334
Practice Address - Country:US
Practice Address - Phone:504-301-1670
Practice Address - Fax:504-309-4413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2013-08-03
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Provider Licenses
StateLicense IDTaxonomies
LA024324207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine