Healthcare Provider Details

I. General information

NPI: 1710637244
Provider Name (Legal Business Name): BRENDAN J. MAUCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 JENA ST STE 205
NEW ORLEANS LA
70115-6322
US

IV. Provider business mailing address

2521 JENA ST STE 205
NEW ORLEANS LA
70115-6322
US

V. Phone/Fax

Practice location:
  • Phone: 504-355-9610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number343302
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2026-00109
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37649
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: