Provider Demographics
NPI:1588686380
Name:DRELL, MARTIN JAY (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JAY
Last Name:DRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 POYDRAS ST
Mailing Address - Street 2:SUITE 1640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-412-1835
Mailing Address - Fax:
Practice Address - Street 1:210 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5735
Practice Address - Country:US
Practice Address - Phone:504-897-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07442R2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369829Medicaid
LA53488F669Medicare PIN
LA53488Medicare PIN
LA1369829Medicaid
LA110181499Medicare PIN