Provider Demographics
NPI:1548252695
Name:MCDONALD, ELIZABETH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:MCDONALD
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:P.O. BOX 54276
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154
Mailing Address - Country:US
Mailing Address - Phone:504-456-5070
Mailing Address - Fax:504-456-5075
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-456-5070
Practice Address - Fax:504-456-5075
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2014-11-05
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
LA017718174400000X
LAMD017718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1389889Medicaid
LA5K092Medicare PIN
LA1389889Medicaid