Healthcare Provider Details

I. General information

NPI: 1689876708
Provider Name (Legal Business Name): MARIANNA ESERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 8TH ST
HARVEY LA
70058-4002
US

IV. Provider business mailing address

2018 8TH ST
HARVEY LA
70058-4002
US

V. Phone/Fax

Practice location:
  • Phone: 504-494-9850
  • Fax:
Mailing address:
  • Phone: 504-494-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number2009003437
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2009003437
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2005018766
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: