Provider Demographics
NPI:1255356002
Name:GUARISCO, CHRISTOPHER PETER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PETER
Last Name:GUARISCO
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 1:3401 NORTH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3743
Mailing Address - Country:US
Mailing Address - Phone:225-336-3100
Mailing Address - Fax:
Practice Address - Street 1:3401 NORTH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3743
Practice Address - Country:US
Practice Address - Phone:225-336-3100
Practice Address - Fax:225-336-3111
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1987573Medicaid
5U306Medicare ID - Type Unspecified
LA1987573Medicaid