Healthcare Provider Details

I. General information

NPI: 1295751006
Provider Name (Legal Business Name): TERRY J LAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/07/2023
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 READ BLVD
NEW ORLEANS LA
70127-3106
US

IV. Provider business mailing address

5610 READ BLVD.
NEW ORLEANS LA
70127-3413
US

V. Phone/Fax

Practice location:
  • Phone: 504-241-8188
  • Fax: 504-264-5941
Mailing address:
  • Phone: 504-241-8188
  • Fax: 504-264-5941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD.201793
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD-201793
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: