Provider Demographics
NPI:1063511590
Name:DOLA, CHI PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:PHUONG
Last Name:DOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3909 LAPALCO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-349-6216
Mailing Address - Fax:985-626-6995
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2302
Practice Address - Country:US
Practice Address - Phone:504-349-6216
Practice Address - Fax:985-626-6995
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA021413207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699071Medicaid
LA5Y670Medicare PIN
LA1699071Medicaid