MEDICARE: DR. MARKALAIN DERY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	DO 000055	LA
2	174400000X	Specialist	DO.000055	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386648822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARKALAIN DERY DO

Provider Business Mailing Address
First Line	:	448 JULIA ST APT 209
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-3600
Country	:	US
Telephone Number	:	504-343-4914
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6203
Country	:	US
Telephone Number	:	504-821-9444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/22/2015

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