MEDICARE: DR. TAMELA L CHARBONNET M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	023735	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215934401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMELA L CHARBONNET M.D.

Provider Business Mailing Address
First Line	:	327 BAYOU GARDENS BLVD
Second Line	:
City	:	HOUMA
State	:	LA
Zip	:	70364-1434
Country	:	US
Telephone Number	:	985-876-5000
Fax Number	:	985-876-5280

Provider Business Practice Location Address
First Line	:	327 BAYOU GARDENS BLVD
Second Line	:
City	:	HOUMA
State	:	LA
Zip	:	70364-1434
Country	:	US
Telephone Number	:	985-876-5000
Fax Number	:	985-876-5280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/09/2007

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