Provider Demographics
NPI:1780670489
Name:ABUSO, CANDICE B (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:B
Last Name:ABUSO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1101 MEDICAL CENTER BLVD
Mailing Address - Street 2:ATTN: HEIDI GWINN
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3147
Mailing Address - Country:US
Mailing Address - Phone:504-349-1297
Mailing Address - Fax:504-349-1146
Practice Address - Street 1:2845 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2987
Practice Address - Country:US
Practice Address - Phone:504-349-6930
Practice Address - Fax:504-361-5496
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-02-03
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Provider Licenses
StateLicense IDTaxonomies
LA13507R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1429091Medicaid
LA1429091Medicaid
LAH16501Medicare UPIN