Healthcare Provider Details

I. General information

NPI: 1811043201
Provider Name (Legal Business Name): EDUARD VARTANOVICH DANILYANTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FOUCHER ST
NEW ORLEANS LA
70115-3515
US

IV. Provider business mailing address

4913 WILLS ST
METAIRIE LA
70006-1132
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-7732
  • Fax: 504-897-7759
Mailing address:
  • Phone: 504-455-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023622
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number023622
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: