Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 1518 | LA |
NPI | 1679705834 |
---|---|
Provider Name | Dr. Benjamin J Dichiara |
First Address | Mandeville, LA 70448-8430 |
Second Address | Metairie, LA 70005-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 11/03/2016 |