MEDICARE: DANA CLAY DICHARRY M.D.

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	207R00000X	Internal Medicine Physician	MD.206111	LA

General Provider Information

NPI Number	:	1588981864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA CLAY DICHARRY M.D.

Provider Business Mailing Address
First Line	:	2621 NORTH DR
Second Line	:	SUITE B
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-4078
Country	:	US
Telephone Number	:	337-470-3075
Fax Number	:	337-470-3079

Provider Business Practice Location Address
First Line	:	2621 NORTH DR
Second Line	:	SUITE B
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-4078
Country	:	US
Telephone Number	:	337-470-3075
Fax Number	:	337-470-3079

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	07/21/2022

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