Healthcare Provider Details

I. General information

NPI: 1093779522
Provider Name (Legal Business Name): MARTHA A CARR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JUDGE TANNER BLVD STE. 200
COVINGTON LA
70433-7503
US

IV. Provider business mailing address

101 JUDGE TANNER BLVD STE. 200
COVINGTON LA
70433-7503
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-8227
  • Fax: 985-871-6920
Mailing address:
  • Phone: 985-871-8227
  • Fax: 985-871-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number015929
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: