MEDICARE: DR. ARWEN EVENSTARA PODESTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	2010369	LA
2	2084P0800X	Psychiatry Physician	200907	LA

General Provider Information

NPI Number	:	1194914598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARWEN EVENSTARA PODESTA M.D.

Provider Business Mailing Address
First Line	:	1511 METAIRIE RD STE 22
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-3938
Country	:	US
Telephone Number	:	504-252-0026
Fax Number	:	504-533-3854

Provider Business Practice Location Address
First Line	:	4322 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-5945
Country	:	US
Telephone Number	:	504-252-0026
Fax Number	:	504-322-3854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/16/2018

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