Provider Demographics
NPI:1326060336
Name:DAL CORSO, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DAL CORSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4148
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70178-4148
Mailing Address - Country:US
Mailing Address - Phone:504-412-1860
Mailing Address - Fax:
Practice Address - Street 1:111 N CAUSEWAY BLVD
Practice Address - Street 2:DAUGHTERS OF CHARITY HEALTH CENTER
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5450
Practice Address - Country:US
Practice Address - Phone:504-482-0084
Practice Address - Fax:504-483-6018
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07331R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1367389Medicaid
LA1367389Medicaid
LA4J076F669Medicare PIN
LA4J076Medicare PIN