Healthcare Provider Details

I. General information

NPI: 1760861348
Provider Name (Legal Business Name): MARADITH LYNN SKALAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARADITH LYNN NOONEN M.D.

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S I 10 SERVICE RD W
METAIRIE LA
70001-1210
US

IV. Provider business mailing address

4740 S I 10 SERVICE RD W STE 200
METAIRIE LA
70001-1244
US

V. Phone/Fax

Practice location:
  • Phone: 504-780-8282
  • Fax:
Mailing address:
  • Phone: 951-315-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35.133601
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number328460
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.133601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: