MEDICARE: MARVIN P DAIR MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200600847	NC
2	207R00000X	Internal Medicine Physician	304038	LA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1427085893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN P DAIR MD

Provider Business Mailing Address
First Line	:	1514 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	504-842-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 LAPALCO BLVD
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-4324
Country	:	US
Telephone Number	:	504-371-9355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/31/2017

1101 MEDICARE CTR. BLVD. , HOSPITALIST DEPARTMENT
MARRERO, LA
70072

Practice Phone: 504-349-1656
Practice Fax: 504-349-1933