Healthcare Provider Details

I. General information

NPI: 1841462710
Provider Name (Legal Business Name): RAVI TANDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 VETERANS MEMORIAL BLVD 200
METAIRIE LA
70002-5634
US

IV. Provider business mailing address

1431 OCTAVIA STREET ADVANCER RECONSTRUCTIVE CARE, LLC
NEW ORLEANS LA
70115
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-1000
  • Fax:
Mailing address:
  • Phone: 504-994-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number262464
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD 202251
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: