Healthcare Provider Details

I. General information

NPI: 1629184635
Provider Name (Legal Business Name): DOREEN T. ABADCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HOSPITAL DR
LAFAYETTE LA
70503-2825
US

IV. Provider business mailing address

PO BOX 80384
LAFAYETTE LA
70598-0384
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5600
  • Fax: 337-269-5812
Mailing address:
  • Phone: 337-269-5600
  • Fax: 337-269-5812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number11594R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD-050174-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: