Provider Demographics
NPI:1225014327
Name:GISTAND, CONSTANCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:M
Last Name:GISTAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL CENTER BLVD
Mailing Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3147
Mailing Address - Country:US
Mailing Address - Phone:504-349-1119
Mailing Address - Fax:504-349-1146
Practice Address - Street 1:1101 MEDICAL CENTER BLVD
Practice Address - Street 2:ATTN: MEDICAL STAFF OFFICE
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3147
Practice Address - Country:US
Practice Address - Phone:504-349-1119
Practice Address - Fax:504-349-1146
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4S701Medicare ID - Type Unspecified
LAH48328Medicare UPIN