Healthcare Provider Details

I. General information

NPI: 1851398622
Provider Name (Legal Business Name): KEITH C. FERDINAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SAINT ANDREW ST
NEW ORLEANS LA
70130-5022
US

IV. Provider business mailing address

1020 SAINT ANDREW ST
NEW ORLEANS LA
70130-5022
US

V. Phone/Fax

Practice location:
  • Phone: 504-529-5558
  • Fax: 504-525-3235
Mailing address:
  • Phone: 504-529-5558
  • Fax: 504-525-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number013565
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.013565
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: