Charles Benjamin Anzalone, DO
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Jefferson, LA
NPI 1497546121 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1497546121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1401A Jefferson Hwy
Jefferson, LA 70121-2426 - Phone
- (504) 842-3260
- Fax
- (504) 842-3193
- NPI assigned
- May 13, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250627000581 | LA | Order and Referring Only - Internal Medicine |
0547773210 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1401A Jefferson Hwy
Jefferson, LA 70121-2426
Mailing address
6151 W End Blvd
New Orleans, LA 70124-2054
Phone (985) 351-8534
Other providers in Jefferson, LA
- Sarah P Anderson
- Sean T Anderson
- Arvind Annamalai
- Stephanie Antonatos
- Amy Sequeira Anzalone
- Fallon Alise Anzalone
- Ridge Michael Arceneaux
- Jennie N Ard
- Rakin Areef
- Stephen Arndt
All providers in Jefferson, LA · Student in an Organized Health Care Education/Training Program in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.