Provider Demographics
NPI:1912964206
Name:DOUGLAS S POOL MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DOUGLAS S POOL MD A MEDICAL CORPORATION
Other - Org Name:DOUGLAS S POOL MD ELSA POOL PHD LCSW A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST PSYCHOANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-835-6320
Mailing Address - Street 1:300 CODIFER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005
Mailing Address - Country:US
Mailing Address - Phone:504-835-6320
Mailing Address - Fax:504-836-6980
Practice Address - Street 1:300 CODIFER BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:504-835-6320
Practice Address - Fax:504-836-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B61139Medicare UPIN
LA5X579Medicare ID - Type Unspecified
LA5K969Medicare ID - Type Unspecified