Healthcare Provider Details

I. General information

NPI: 1700996840
Provider Name (Legal Business Name): RICHARD CELENTANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAKEVIEW DR SUITE 200
COVINGTON LA
70433-7511
US

IV. Provider business mailing address

110 LAKEVIEW LANE SUITE 200
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-0589
  • Fax:
Mailing address:
  • Phone: 985-898-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number013925
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: