Healthcare Provider Details

I. General information

NPI: 1699160341
Provider Name (Legal Business Name): ASHA KHACHANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JUDGE TANNER BLVD STE 106
COVINGTON LA
70433-7504
US

IV. Provider business mailing address

1100 POYDRAS ST. 2500 ENERGY CENTRE
NEW ORLEANS LA
70163-2500
US

V. Phone/Fax

Practice location:
  • Phone: 985-867-2128
  • Fax: 833-573-1393
Mailing address:
  • Phone: 504-527-9953
  • Fax: 504-527-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number338521
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: