Provider Demographics
NPI:1083631089
Name:ABELL, MARY MOORE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MOORE
Last Name:ABELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SAINT ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5022
Mailing Address - Country:US
Mailing Address - Phone:504-529-5558
Mailing Address - Fax:
Practice Address - Street 1:1020 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5022
Practice Address - Country:US
Practice Address - Phone:504-529-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD017380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1361283Medicaid
LA1361283Medicaid