Healthcare Provider Details

I. General information

NPI: 1043523277
Provider Name (Legal Business Name): THARWAT A. GHATTAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 MARK DR
MONROE LA
71201-5152
US

IV. Provider business mailing address

1455 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71105-5634
US

V. Phone/Fax

Practice location:
  • Phone: 318-460-5127
  • Fax: 318-460-1967
Mailing address:
  • Phone: 318-798-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.206802
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD.206802
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: