Healthcare Provider Details

I. General information

NPI: 1841281490
Provider Name (Legal Business Name): CHARLES RAYMOND PARSIOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 CHITIMACHA TRAIL
CHARENTON LA
70523
US

IV. Provider business mailing address

PO BOX 640
CHARENTON LA
70523-0640
US

V. Phone/Fax

Practice location:
  • Phone: 337-923-9955
  • Fax: 337-923-7791
Mailing address:
  • Phone: 337-923-9955
  • Fax: 337-923-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12053R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: