Provider Demographics
NPI:1699074583
Name:HAYDEL, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:HAYDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PRYTANIA ST STE 602
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-8141
Mailing Address - Country:US
Mailing Address - Phone:504-232-3288
Mailing Address - Fax:
Practice Address - Street 1:3525 PRYTANIA ST STE 602
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-8141
Practice Address - Country:US
Practice Address - Phone:504-232-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics