Provider Demographics
NPI:1861440331
Name:HEAD, LIONEL H (MD)
Entity type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:H
Last Name:HEAD
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 1:309 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2003
Mailing Address - Country:US
Mailing Address - Phone:504-737-8243
Mailing Address - Fax:
Practice Address - Street 1:309 GARDEN RD
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2003
Practice Address - Country:US
Practice Address - Phone:504-737-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.008984207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122264Medicaid
LA1103195Medicaid
LA1103195Medicaid
LA5L1707061Medicare PIN
LA5L170Medicare ID - Type Unspecified