Basic Information
| Provider Information | |||||||||
| NPI: | 1891985362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUR | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | PELLEGRIN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PELLEGRIN | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4228 HOUMA BLVD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700063021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048833770 | ||||||||
| FaxNumber: | 5048833711 | ||||||||
| Practice Location | |||||||||
| Address1: | 4228 HOUMA BLVD. | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048833770 | ||||||||
| FaxNumber: | 5048833711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD.202185 | LA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1006670 | 05 | LA | MEDICAID |