Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD.201122 | LA |
NPI | 1538129135 |
---|---|
Provider Name | Dr. Mary T Killackey |
First Address | New Orleans, LA 70112-2600 |
Second Address | New Orleans, LA 70112-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 20/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101398841 | (05) | PA |
1455172 | (05) | LA |
I00323 | (02) |