Healthcare Provider Details

I. General information

NPI: 1033180583
Provider Name (Legal Business Name): EDWARD F PITARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ROBERT E LEE BLVD
NEW ORLEANS LA
70124-2545
US

IV. Provider business mailing address

602 ROBERT E LEE BLVD
NEW ORLEANS LA
70124-2545
US

V. Phone/Fax

Practice location:
  • Phone: 504-888-4040
  • Fax: 504-888-5959
Mailing address:
  • Phone: 504-888-4040
  • Fax: 504-888-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number015724
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: