Healthcare Provider Details

I. General information

NPI: 1366417339
Provider Name (Legal Business Name): MOHAN D GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 MILLING AVE
LULING LA
70070-4442
US

IV. Provider business mailing address

5805 CLEVELAND PL
METAIRIE LA
70003-1057
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-5800
  • Fax: 985-785-5804
Mailing address:
  • Phone: 504-885-1319
  • Fax: 985-785-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: