Healthcare Provider Details

I. General information

NPI: 1164427753
Provider Name (Legal Business Name): MARY E. LOBRANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD
METAIRIE LA
70006-2970
US

IV. Provider business mailing address

PO BOX 8090
METAIRIE LA
70011-8090
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-4133
  • Fax: 504-456-8125
Mailing address:
  • Phone: 504-454-4133
  • Fax: 504-456-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22095
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: