Provider Demographics
NPI:1306183645
Name:MEDICAL & DIAGNOSTIC CLINIC,LLC
Entity Type:Organization
Organization Name:MEDICAL & DIAGNOSTIC CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IRSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DACNB,FACFN
Authorized Official - Phone:225-761-1981
Mailing Address - Street 1:10620 TIMBERLAKE AVE
Mailing Address - Street 2:BLDG 3
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6614
Mailing Address - Country:US
Mailing Address - Phone:225-761-1981
Mailing Address - Fax:225-761-1983
Practice Address - Street 1:10620 TIMBERLAKE AVE
Practice Address - Street 2:BLDG 3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6614
Practice Address - Country:US
Practice Address - Phone:225-761-1981
Practice Address - Fax:225-761-1983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL & DIAGNOSTIC CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-07
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1266261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty