Provider Demographics
NPI:1235245705
Name:PERSICH, NICHOLAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:PERSICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3002
Mailing Address - Country:US
Mailing Address - Phone:504-456-6701
Mailing Address - Fax:504-456-6843
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3002
Practice Address - Country:US
Practice Address - Phone:504-456-6701
Practice Address - Fax:504-456-6843
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA019601207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5372667009OtherCIGNA
4413302OtherAETNA
LA1930989Medicaid
LA4334849824EOtherBLUE CROSS
4413302OtherAETNA
F31185Medicare UPIN