MEDICARE: DONNA M MANCUSO 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	102L00000X	Psychoanalyst	17303	LA
2	2084F0202X	Forensic Psychiatry Physician	17303	LA
3	2084P0800X	Psychiatry Physician	17303	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1649245069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M MANCUSO MD

Provider Business Mailing Address
First Line	:	1301 ANTONINE STREET
Second Line	:	SUITE 500
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115
Country	:	US
Telephone Number	:	504-208-1035
Fax Number	:	504-891-3039

Provider Business Practice Location Address
First Line	:	1301 ANTONINE ST
Second Line	:	SUITE 500
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-3601
Country	:	US
Telephone Number	:	504-208-1035
Fax Number	:	504-891-3039

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	05/05/2015

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Directions to “ DONNA M MANCUSO MD” Practice Location

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