Provider Demographics
NPI:1215934401
Name:CHARBONNET, TAMELA L (MD)
Entity type:Individual
Prefix:DR
First Name:TAMELA
Middle Name:L
Last Name:CHARBONNET
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 1:327 BAYOU GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1434
Mailing Address - Country:US
Mailing Address - Phone:985-876-5000
Mailing Address - Fax:985-876-5280
Practice Address - Street 1:327 BAYOU GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1434
Practice Address - Country:US
Practice Address - Phone:985-876-5000
Practice Address - Fax:985-876-5280
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023735207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441953Medicaid
LA1484768Medicaid
LA1484768Medicaid
LAH40895Medicare UPIN
LA5C904Medicare ID - Type UnspecifiedMEDICARE GROUP #