Healthcare Provider Details

I. General information

NPI: 1396780193
Provider Name (Legal Business Name): WOMAN'S MATERNAL FETAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 AIRLINE HIGHWAY SUITE 370
BATON ROUGE LA
70815-4114
US

IV. Provider business mailing address

9000 AIRLINE HIGHWAY SUITE 370
BATON ROUGE LA
70815-4114
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-8338
  • Fax: 225-922-3745
Mailing address:
  • Phone: 225-924-8338
  • Fax: 225-922-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TERI G FONTENOT
Title or Position: CEO AND PRESIDENT
Credential:
Phone: 225-927-1300