Provider Demographics
NPI:1922276740
Name:CRAPANZANO, PETER BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BRIAN
Last Name:CRAPANZANO
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 1:8901 CHRETIEN POINT PL
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BEACON HEALING & WELLNESS, LLC
Practice Address - Street 2:671 RIVER HIGHLANDS BLVD., SUITE 8
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:985-888-1120
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.09780R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1689475Medicaid
LA1689475Medicaid