MEDICARE: MARY CONNOLLY

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	207R00000X	Internal Medicine Physician	350895	LA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942946587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CONNOLLY

Provider Business Mailing Address
First Line	:	3600 FORBES AVE STE 140
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 MEDICAL CENTER BLVD
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3147
Country	:	US
Telephone Number	:	504-349-1656
Fax Number	:	504-349-1933

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

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	05/22/2026

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Directions to “ MARY CONNOLLY ” Practice Location

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