Healthcare Provider Details

I. General information

NPI: 1780823765
Provider Name (Legal Business Name): THE SPECIALIST GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 ORMOND BLVD SUITE B
DESTREHAN LA
70047-3818
US

IV. Provider business mailing address

1972 ORMOND BLVD SUITE B
DESTREHAN LA
70047-3818
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-1441
  • Fax: 985-764-1422
Mailing address:
  • Phone: 985-764-1441
  • Fax: 985-764-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIUS SHARON
Title or Position: CEO
Credential: MD
Phone: 985-764-1441