=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881764827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEONATOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 JACKSON ST 4TH FLOOR NICU
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-7407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-327-4917
-----------------------------------------------------
Fax | 318-327-4916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 SAINT CHARLES CIRCLE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-325-4575
-----------------------------------------------------
Fax | 318-323-4153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARC DESOLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 318-327-4617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number | 08063R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number | 10844R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------