Healthcare Provider Details

I. General information

NPI: 1255501052
Provider Name (Legal Business Name): MIA H WEBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BELLE CHASSE HWY STE 101
TERRYTOWN LA
70056-7057
US

IV. Provider business mailing address

PO BOX 1156
GRETNA LA
70054-1156
US

V. Phone/Fax

Practice location:
  • Phone: 504-569-5327
  • Fax: 504-323-3153
Mailing address:
  • Phone: 504-569-5327
  • Fax: 504-323-3153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.202558
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: