Healthcare Provider Details

I. General information

NPI: 1306165097
Provider Name (Legal Business Name): ANDRE DOMINICK TILTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S CARROLLTON AVE
NEW ORLEANS LA
70119-6817
US

IV. Provider business mailing address

6621 WESTBANK EXPY
MARRERO LA
70072-2669
US

V. Phone/Fax

Practice location:
  • Phone: 504-446-1390
  • Fax: 877-473-0040
Mailing address:
  • Phone: 504-309-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28991
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2019-0172
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036139441
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.205203
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: