Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD.020576 | LA |
NPI | 1043271612 |
---|---|
Provider Name | Charles J Dicorte |
First Address | New Orleans, LA 70121-2429 |
Second Address | Covington, LA 70433-8107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G85189 | (02) |