Healthcare Provider Details

I. General information

NPI: 1639124290
Provider Name (Legal Business Name): RUSSELL PATRICK CECOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N JEFFERSON DAVIS PKWY
NEW ORLEANS LA
70119-5308
US

IV. Provider business mailing address

120 N JEFFERSON DAVIS PKWY
NEW ORLEANS LA
70119-5308
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-0244
  • Fax: 504-821-0255
Mailing address:
  • Phone: 504-821-0244
  • Fax: 504-821-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number019853
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number019853
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: