Provider Demographics
NPI:1194302653
Name:PICCIOLA, EMILY CAMILLE (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAMILLE
Last Name:PICCIOLA
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-6346
Mailing Address - Fax:225-526-0636
Practice Address - Street 1:8415 GOODWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-765-6346
Practice Address - Fax:225-765-8585
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010149314208000000X
LA341263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics