Provider Demographics
NPI:1316289119
Name:MUSACCHIA, PAMELA GAYLE (MS, MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:GAYLE
Last Name:MUSACCHIA
Suffix:
Gender:F
Credentials:MS, MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:GAYLE
Other - Last Name:TAGGART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:4225 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4324
Practice Address - Country:US
Practice Address - Phone:504-391-7337
Practice Address - Fax:504-398-7213
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2329332Medicaid
MS04073541Medicaid
LA2329332Medicaid