Healthcare Provider Details

I. General information

NPI: 1922002856
Provider Name (Legal Business Name): REITA LAWRENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KINGMAN ST STE 110
METAIRIE LA
70006-5419
US

IV. Provider business mailing address

298 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-887-6355
  • Fax: 504-888-3747
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 Number18871
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: