Healthcare Provider Details

I. General information

NPI: 1306193917
Provider Name (Legal Business Name): SUSHANT D GHATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

5709 WILLOW ST
NEW ORLEANS LA
70115-7063
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9569
  • Fax:
Mailing address:
  • Phone: 504-481-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberGETP
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: