Provider Demographics
NPI:1730239708
Name:MCBRIDE, LORI A (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:MCBRIDE
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 1:5959 S SHERWOOD FOREST BLVD # A11
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0013
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:7777 HENNESSY BLVD STE 306
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4365
Practice Address - Country:US
Practice Address - Phone:225-765-6834
Practice Address - Fax:225-765-5543
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200135207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1622320Medicaid
H00306Medicare UPIN
LA1622320Medicaid