Provider Demographics
NPI:1386149144
Name:TAGORDA, LAUREN ANNE (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:TAGORDA
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 1:110 ACADIA PARK DR
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2618
Mailing Address - Country:US
Mailing Address - Phone:985-537-8687
Mailing Address - Fax:985-537-8976
Practice Address - Street 1:110 ACADIA PARK DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2618
Practice Address - Country:US
Practice Address - Phone:985-537-8687
Practice Address - Fax:985-537-8976
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA326410208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program