Healthcare Provider Details

I. General information

NPI: 1134461262
Provider Name (Legal Business Name): MARIAM CARPENTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD FL 6
METAIRIE LA
70006-2970
US

IV. Provider business mailing address

4200 HOUMA BLVD FL 6
METAIRIE LA
70006-2970
US

V. Phone/Fax

Practice location:
  • Phone: 504-503-4331
  • Fax: 504-503-4341
Mailing address:
  • Phone: 504-503-4331
  • Fax: 504-503-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.207228
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.207228
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: