Basic Information
| Provider Information | |||||||||
| NPI: | 1699798603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARBLE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HENRY CLAY AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701185720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121835 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CHILDREN'S HOSPITAL - GENETICS | ||||||||
| Address2: | 200 HENRY CLAY AVE | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048969254 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SG0201X | 10120R | LA | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 207SG0202X | 10120R | LA | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Biochemical Genetics | 208000000X | 10120R | LA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207SG0201X | 89-257 | NM | Y | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) |
ID Information
| ID | Type | State | Issuer | Description | 00112369 | 05 | MS | MEDICAID | 1974358 | 05 | LA | MEDICAID |