Individual
DOMINIC STEPHEN CAROLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121-2429
(504) 842-3755
(504) 842-3193
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121
(504) 842-4000
(504) 842-3193
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD3201535
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03400891
—
MS
05
—
1077224
—
LA
Enumeration date
07/26/2007
Last updated
10/04/2011
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