Healthcare Provider Details

I. General information

NPI: 1386648822
Provider Name (Legal Business Name): MARKALAIN DERY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 CANAL ST
NEW ORLEANS LA
70119-6203
US

IV. Provider business mailing address

448 JULIA ST APT 209
NEW ORLEANS LA
70130-3600
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9444
  • Fax:
Mailing address:
  • Phone: 504-343-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDO.000055
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberDO 000055
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: