MEDICARE: JUSTIN JOHN FARGE MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0207X	Pediatric Hematology & Oncology Physician	48709	KY
2	2080P0207X	Pediatric Hematology & Oncology Physician	321048	LA

General Provider Information

NPI Number	:	1548502313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN JOHN FARGE MD

Provider Business Mailing Address
First Line	:	131 S ROBERTSON ST # 8027
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2807
Country	:	US
Telephone Number	:	504-988-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 S ROBERTSON ST # 8027
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2807
Country	:	US
Telephone Number	:	504-988-5413
Fax Number	:

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

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	10/28/2019

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Directions to “ JUSTIN JOHN FARGE MD” Practice Location

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