Thomas Nicotri Jr MD LLC

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

023801 Issued in LA

Legal business name

THOMAS NICOTRI JR MD LLC

Practice address

1305 W Causeway Approach Ste 209
Mandeville, LA 70471-3043

Phone

(985) 626-6996

Fax

(985) 626-6995

NPI assigned

Nov 15, 2006

Last updated

Nov 5, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas Nicotri Jr., MD

Title

President

Phone

(985) 626-6996

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1487727921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1536",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704701536",
            "telephone_number": "985-662-6699",
            "fax_number": "985-626-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W CAUSEWAY APPROACH STE 209",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713043",
            "telephone_number": "985-626-6996",
            "fax_number": "985-626-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS NICOTRI JR MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "NICOTRI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-626-6996",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "LA",
            "license": "023801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1485268",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatopathology Physician in Mandeville, LA
• Providers in Mandeville, LA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.