Provider Demographics
NPI:1740224963
Name:CULOTTA, VINCENT ANTHONY JR (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:ANTHONY
Last Name:CULOTTA
Suffix:JR
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:STE 200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3004
Mailing Address - Country:US
Mailing Address - Phone:504-454-7878
Mailing Address - Fax:504-883-3775
Practice Address - Street 1:4420 CONLIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2167
Practice Address - Country:US
Practice Address - Phone:504-872-9283
Practice Address - Fax:504-298-1032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2017-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD012614207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1107107Medicaid
LA1107107Medicaid
B26883Medicare UPIN