Active NPI
Dolleen Licciardi, MD
- Pediatrics Physician
- Destrehan, LA
National Provider Identifier
1629072558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 17300
- Practice address
- 141 Ormond Center CT
Destrehan, LA 70047-2548 - Phone
- (985) 764-7337
- Fax
- (985) 764-5333
- NPI assigned
- Jun 9, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 17300 | LA | Primary |
Addresses
Primary practice location
141 Ormond Center CT
Destrehan, LA 70047-2548
Mailing address
298 Henry Clay Ave
New Orleans, LA 70118-5720
Phone (504) 896-9827
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1364045 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17300 | LA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294358400000",
"number": "1629072558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "298 HENRY CLAY AVE",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701185720",
"telephone_number": "504-896-9827",
"fax_number": "504-894-5370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 ORMOND CENTER CT",
"city": "DESTREHAN",
"state": "LA",
"postal_code": "700472548",
"telephone_number": "985-764-7337",
"fax_number": "985-764-5333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICCIARDI",
"first_name": "DOLLEEN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-09",
"last_updated": "2011-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "LA",
"license": "17300",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1364045",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Destrehan, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.