Healthcare Provider Details

I. General information

NPI: 1366923542
Provider Name (Legal Business Name): ARCHANA SRINIVASAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOUMA BLVD
METAIRIE LA
70006-2933
US

IV. Provider business mailing address

131 S ROBERTSON ST
NEW ORLEANS LA
70112-2807
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5831
  • Fax:
Mailing address:
  • Phone: 267-969-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number343426
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number343426
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: