Provider Demographics
NPI:1811164098
Name:ONG, MARICELLE ORACION (MD)
Entity type:Individual
Prefix:
First Name:MARICELLE
Middle Name:ORACION
Last Name:ONG
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 1:200 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-471-2757
Mailing Address - Fax:504-471-2764
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-471-2757
Practice Address - Fax:504-471-2764
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
CAA113922207Q00000X
LAMD204585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program