Healthcare Provider Details

I. General information

NPI: 1639512437
Provider Name (Legal Business Name): MARIO L. CARDINALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6902
US

IV. Provider business mailing address

4640 AMBASSADOR CAFFERY PKWY DEPT OF
LAFAYETTE LA
70508-6902
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-1050
  • Fax: 337-984-8776
Mailing address:
  • Phone: 337-984-1050
  • Fax: 337-984-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number305068
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: