Provider Demographics
NPI:1679764013
Name:HENEGHAN, JAMES PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PHILLIP
Last Name:HENEGHAN
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 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 1018
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-895-4505
Mailing Address - Fax:504-895-1093
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 1018
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-895-4505
Practice Address - Fax:504-895-1093
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC16808Medicare UPIN
LA5N086D565Medicare PIN