Healthcare Provider Details

I. General information

NPI: 1366936122
Provider Name (Legal Business Name): MARY KATHERINE VAN WERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SAINT CHARLES AVE
NEW ORLEANS LA
70130-5223
US

IV. Provider business mailing address

1717 SAINT CHARLES AVE
NEW ORLEANS LA
70130-5223
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-2800
  • Fax: 504-899-2700
Mailing address:
  • Phone: 504-899-2800
  • Fax: 504-899-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number322923
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: