Healthcare Provider Details

I. General information

NPI: 1003812215
Provider Name (Legal Business Name): RADIOLOGY & INTERVENTIONAL ASSOCIATES OF METAIRIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD
METAIRIE LA
70006-2970
US

IV. Provider business mailing address

PO BOX 8090
METAIRIE LA
70011-8090
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-4133
  • Fax: 504-456-8125
Mailing address:
  • Phone: 504-454-4133
  • Fax: 504-456-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. BERNARD G MARISTANY
Title or Position: MD
Credential:
Phone: 504-454-4133