Healthcare Provider Details

I. General information

NPI: 1689937385
Provider Name (Legal Business Name): OMEED MOAVEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE RM 734
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

1542 TULANE AVE RM 734
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4750
  • Fax: 504-568-4633
Mailing address:
  • Phone: 504-568-4750
  • Fax: 504-568-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME145895
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-252944
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number330558
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number330558
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: