Basic Information
Provider Information
NPI: 1760724157
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COUVILLION
FirstName: MEGAN
MiddleName: POYNOT
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1430 TULANE AVE # 8036
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701122632
CountryCode: US
TelephoneNumber: 5049887809
FaxNumber: 5049883971
Practice Location
Address1: 1430 TULANE AVE
Address2: #8036
City: NEW ORLEANS
State: LA
PostalCode: 701122632
CountryCode: US
TelephoneNumber: 5049885114
FaxNumber: 5049887382
Other Information
ProviderEnumerationDate: 03/23/2013
LastUpdateDate: 08/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X208121LAY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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