Healthcare Provider Details

I. General information

NPI: 1477505071
Provider Name (Legal Business Name): MARY A HOBBS MALUCCIO MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY A MALUCCIO MD, MPH

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4204 HOUMA BLVD
METAIRIE LA
70006-2903
US

IV. Provider business mailing address

3621 LAKE DR
METAIRIE LA
70002-1533
US

V. Phone/Fax

Practice location:
  • Phone: 504-503-5426
  • Fax:
Mailing address:
  • Phone: 462-671-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number311861
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number01059879A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: