Provider Demographics
NPI:1316955495
Name:HADDAD, CHARLES G JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:HADDAD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2921
Mailing Address - Country:US
Mailing Address - Phone:504-885-6464
Mailing Address - Fax:504-885-6414
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2921
Practice Address - Country:US
Practice Address - Phone:504-885-6464
Practice Address - Fax:504-885-6414
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA200175207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
303309OtherCOVENTRY
LA1628158Medicaid
LA1628158Medicaid
0271350001Medicare NSC
P00255017Medicare PIN