Healthcare Provider Details

I. General information

NPI: 1760458566
Provider Name (Legal Business Name): CHRIS J DIGRADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARATARIA BLVD
MARRERO LA
70072-3703
US

IV. Provider business mailing address

1301 BARATARIA BLVD
MARRERO LA
70072-3703
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-0243
  • Fax: 504-349-2910
Mailing address:
  • Phone: 504-347-0243
  • Fax: 504-349-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.012266
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD.012266
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: