Active NPI
Peggy H. Polk, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Baton Rouge, LA
National Provider Identifier
1225098155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- MD.020656
- Practice address
- 5339 Odonavan
Baton Rouge, LA 70808-4388 - Phone
- (225) 766-4999
- Fax
- (225) 763-5870
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD.020656 | LA | Primary |
Addresses
Primary practice location
5339 Odonavan
Baton Rouge, LA 70808-4388
Mailing address
5339 Odonavan
Baton Rouge, LA 70808-4388
Phone (225) 766-4999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1690660 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.020656 | LA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204761600000",
"number": "1225098155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5339 ODONAVAN",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708084388",
"telephone_number": "225-766-4999",
"fax_number": "225-763-5870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5339 ODONAVAN",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708084388",
"telephone_number": "225-766-4999",
"fax_number": "225-763-5870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLK",
"first_name": "PEGGY",
"middle_name": "H.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2008-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "LA",
"license": "MD.020656",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1690660",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.