Provider Demographics
NPI:1578564134
Name:DUPIN, CHARLES LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LOUIS
Last Name:DUPIN
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 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE S 640
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6460
Mailing Address - Fax:504-349-6463
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:STE S 640
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6460
Practice Address - Fax:504-349-6463
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.011012208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09274771Medicaid
LA1195740Medicaid
LA1195740Medicaid
LA513257061Medicare PIN
B62976Medicare UPIN
LA51325F669Medicare PIN