Healthcare Provider Details

I. General information

NPI: 1619291622
Provider Name (Legal Business Name): AMIT CHAWLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

1542 TULANE AVE
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-423-3476
  • Fax:
Mailing address:
  • Phone: 504-423-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number72-60877
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: