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General NPI Number Information
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NPI Number | 1164454849
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Entity Type | Individual
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Provider Name | TRACIE MANUEL BELLANGER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1805 JACKSON ST
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City | MONROE
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State | LA
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Zip | 71202-2529
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Country | US
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Telephone | 318-966-4000
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Fax | 318-966-7364
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Provider Business Mailing Address
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Address Line | 5959 S SHERWOOD FOREST BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-6038
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Country | US
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Telephone | 318-966-4000
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Fax | 225-765-9196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2009-01134
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 024891
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License Number State | LA
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