Healthcare Provider Details

I. General information

NPI: 1801890744
Provider Name (Legal Business Name): ANTOINETTE LOGARBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 W 11TH AVE
COVINGTON LA
70433-2318
US

IV. Provider business mailing address

298 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-3395
  • Fax: 985-892-8212
Mailing address:
  • Phone: 504-896-9827
  • Fax: 504-894-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16586
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: