Provider Demographics
NPI:1447301627
Name:CRESCENT SURGICAL GROUP, L.L.C.
Entity type:Organization
Organization Name:CRESCENT SURGICAL GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KAPPELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-391-7660
Mailing Address - Street 1:120 MEADOWCREST ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5255
Mailing Address - Country:US
Mailing Address - Phone:504-391-7660
Mailing Address - Fax:504-393-2407
Practice Address - Street 1:120 MEADOWCREST ST
Practice Address - Street 2:SUITE 450
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5255
Practice Address - Country:US
Practice Address - Phone:504-391-7660
Practice Address - Fax:504-393-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACS9735OtherRAILROAD MEDICARE
LA5CP18Medicare ID - Type Unspecified