Healthcare Provider Details

I. General information

NPI: 1346008810
Provider Name (Legal Business Name): MIA MCFADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/26/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LSU OBGYN RESIDENCY PROGRAM, 500 RUE DE LA VIE SUITE 404
BATON ROUGE LA
70817
US

IV. Provider business mailing address

LSU OBGYN RESIDENCY PROGRAM, 500 RUE DE LA VIE SUITE 404
BATON ROUGE LA
70817
US

V. Phone/Fax

Practice location:
  • Phone: 225-215-7960
  • Fax:
Mailing address:
  • Phone: 225-215-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: