Provider Demographics
NPI:1699712869
Name:THALY, LATA K (MD)
Entity type:Individual
Prefix:
First Name:LATA
Middle Name:K
Last Name:THALY
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 1:72 LAKEWOOD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8358
Mailing Address - Country:US
Mailing Address - Phone:504-228-2077
Mailing Address - Fax:
Practice Address - Street 1:1978 INDUSTRIAL BLVD
Practice Address - Street 2:LEONARD CHABERT MEDICAL CENTER
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363
Practice Address - Country:US
Practice Address - Phone:985-873-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14514207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1325791Medicaid
LA1325791Medicaid
LA5M5397627Medicare PIN
LAD74103Medicare UPIN