Mary Fontenot Anderson, MD
Individual provider Active NPI Family Medicine Physician · Covington, LA
NPI 1174053292 · NPPES record last updated Nov 12, 2020
Key facts
- NPI
- 1174053292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 309400 (LA)
- Practice address
- 100 Christwood Blvd
Covington, LA 70433-4606 - Phone
- (985) 256-5690
- NPI assigned
- Jun 13, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201118000291 | LA | Order and Referring Only - Family Practice |
9335403161 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 309400 | LA | Yes |
Addresses
Primary practice location
100 Christwood Blvd
Covington, LA 70433-4606
Mailing address
100 Christwood Blvd
Covington, LA 70433-4606
Phone (985) 256-5690
Other providers in Covington, LA
- Christopher Charles Anderson
- Courtney L Anderson
- Dejia Danielle Anderson
- Jeana Anderson
- Katelyn M. Anderson
- Rebecca Danae Anderson
- Russell Lee Anderson
- Javunte Darnell Andrews
- Jeffrey J. Andry Sr.
- Denise Angelica
All providers in Covington, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.