Provider Demographics
NPI:1508861642
Name:DIVINCENTI, FRANK C (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:C
Last Name:DIVINCENTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE 713N
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6713
Mailing Address - Fax:504-349-6733
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 713N
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6713
Practice Address - Fax:504-349-6733
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA009228208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1107514Medicaid
LA1107514Medicaid
LA51293Medicare ID - Type Unspecified