Healthcare Provider Details

I. General information

NPI: 1508691973
Provider Name (Legal Business Name): MARC STYLMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 LAPALCO BLVD
MARRERO LA
70072-4324
US

IV. Provider business mailing address

511 RED ALLEN WAY
NEW ORLEANS LA
70114
US

V. Phone/Fax

Practice location:
  • Phone: 504-371-9355
  • Fax:
Mailing address:
  • Phone: 201-755-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number343768
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: