=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144088956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNOR MARK CHAMBERLAIN PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2024
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3939 HOUMA BLVD STE 21
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-885-6464
-----------------------------------------------------
Fax | 504-247-0562
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 961 HARRISON AVE
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70124-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-756-2453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 344077
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------