Provider Demographics
NPI:1881764827
Name:NEONATOLOGY ASSOCIATES
Entity type:Organization
Organization Name:NEONATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:DESOLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-327-4617
Mailing Address - Street 1:121 SAINT CHARLES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203
Mailing Address - Country:US
Mailing Address - Phone:318-325-4575
Mailing Address - Fax:318-323-4153
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:4TH FLOOR NICU
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-327-4917
Practice Address - Fax:318-327-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08063R2080N0001X
LA10844R2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0456817720OtherBLUE CROSS
LA1659746Medicaid
LA1382141Medicaid
LA1382141Medicaid
LA1659746Medicaid
LAE48579Medicare ID - Type Unspecified