Healthcare Provider Details

I. General information

NPI: 1922635044
Provider Name (Legal Business Name): WADIA HAMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

IV. Provider business mailing address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-8743
  • Fax:
Mailing address:
  • Phone: 985-280-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number337951
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME158382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: