Healthcare Provider Details

I. General information

NPI: 1619929080
Provider Name (Legal Business Name): LIONEL ANDREW BRANCH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 POYDRAS STREET
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1542 TULANE AVE RM 763
NEW ORLEANS LA
70112
US

V. Phone/Fax

Practice location:
  • Phone: 504-258-1086
  • Fax: 225-644-4909
Mailing address:
  • Phone: 504-568-4080
  • Fax: 225-644-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number023313
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number023313
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: