Healthcare Provider Details

I. General information

NPI: 1952556094
Provider Name (Legal Business Name): CHAD W TROSCLAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HIGHWAY 190 EAST SERVICE RD STE D5
COVINGTON LA
70433-4956
US

IV. Provider business mailing address

5001 HIGHWAY 190 EAST SERVICE RD STE D5
COVINGTON LA
70433-4956
US

V. Phone/Fax

Practice location:
  • Phone: 985-377-2828
  • Fax:
Mailing address:
  • Phone: 985-377-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number18116
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number024643
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: