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NPI Code Detail

MEDICARE: DR. CHARLES VACCARO MENENDEZ JR. M.D.

MEDICARE:  DR. CHARLES VACCARO MENENDEZ JR. 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
12085R0202XDiagnostic Radiology Physician13597MS

Other Identifiers

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

General Provider Information

NPI Number : 1629008974
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES VACCARO MENENDEZ JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 2710
Second Line :
City : SLIDELL
State : LA
Zip : 70459-2710
Country : US
Telephone Number : 228-762-1353
Fax Number :
Provider Business Practice Location Address
First Line : 3109 BIENVILLE BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-4361
Country : US
Telephone Number : 228-762-1353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 03/07/2018

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Directions to “ DR. CHARLES VACCARO MENENDEZ JR. M.D.” Practice Location

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