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General NPI Number Information
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NPI Number | 1780994079
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Entity Type | Organization
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Legal Business Name | C. EDWARD FOTI, M.D., A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 3106 HOUMA BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-5406
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Country | US
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Telephone | 504-250-1714
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Fax | 504-455-5751
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Provider Business Mailing Address
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Address Line | 3106 HOUMA BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-5406
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Country | US
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Telephone | 504-250-1714
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Fax | 504-455-5751
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROL EDWARD FOTI
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Credential | M.D.
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Telephone | 504-250-1714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 10166
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License Number State | LA
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