Healthcare Provider Details

I. General information

NPI: 1093768293
Provider Name (Legal Business Name): CHARLES JOSEPH CUCCHIARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHUCK CUCCHIARA

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD STE 200
METAIRIE LA
70006
US

IV. Provider business mailing address

4228 HOUMA BLVD STE 200
METAIRIE LA
70006-3000
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-7878
  • Fax: 504-883-3775
Mailing address:
  • Phone: 504-454-7878
  • Fax: 504-883-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD010401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: