Healthcare Provider Details

I. General information

NPI: 1174835631
Provider Name (Legal Business Name): DURGA P NAIDU M.D, FAAP, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 CAMELLIA BLVD STE 101
LAFAYETTE LA
70508-7248
US

IV. Provider business mailing address

1003 CAMELLIA BLVD STE 101
LAFAYETTE LA
70508-7248
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6892
  • Fax: 337-735-3038
Mailing address:
  • Phone: 337-456-6892
  • Fax: 337-735-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number304683
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: