Healthcare Provider Details

I. General information

NPI: 1326212226
Provider Name (Legal Business Name): QUOC BAO LY HOANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 TERRY PKWY
TERRYTOWN LA
70056-2780
US

IV. Provider business mailing address

441 TERRY PKWY
TERRYTOWN LA
70056-2780
US

V. Phone/Fax

Practice location:
  • Phone: 504-319-5267
  • Fax:
Mailing address:
  • Phone: 504-319-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2010-00332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: