Healthcare Provider Details

I. General information

NPI: 1780994079
Provider Name (Legal Business Name): C. EDWARD FOTI, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 HOUMA BLVD
METAIRIE LA
70006-5406
US

IV. Provider business mailing address

3106 HOUMA BLVD
METAIRIE LA
70006-5406
US

V. Phone/Fax

Practice location:
  • Phone: 504-250-1714
  • Fax: 504-455-5751
Mailing address:
  • Phone: 504-250-1714
  • Fax: 504-455-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number10166
License Number StateLA

VIII. Authorized Official

Name: DR. CAROL EDWARD FOTI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 504-250-1714