1093768293 NPI number — CHARLES JOSEPH CUCCHIARA MD

Table of content: CHARLES JOSEPH CUCCHIARA MD (NPI 1093768293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093768293 NPI number — CHARLES JOSEPH CUCCHIARA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUCCHIARA
Provider First Name:
CHARLES
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUCCHIARA
Provider Other First Name:
CHUCK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1093768293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4228 HOUMA BLVD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-454-7878
Provider Business Mailing Address Fax Number:
504-883-3775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 HOUMA BLVD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-454-7878
Provider Business Practice Location Address Fax Number:
504-883-3775
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD010401 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1103217 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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