Provider Demographics
NPI:1326123563
Name:IATCHOVSKI-BARONNE, IVO (MD)
Entity Type:Individual
Prefix:DR
First Name:IVO
Middle Name:
Last Name:IATCHOVSKI-BARONNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IVO
Other - Middle Name:TZVETANOV
Other - Last Name:IATCHOVSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3017 HARVARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6402
Mailing Address - Country:US
Mailing Address - Phone:504-338-4042
Mailing Address - Fax:504-885-2904
Practice Address - Street 1:3017 HARVARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6494
Practice Address - Country:US
Practice Address - Phone:504-885-7018
Practice Address - Fax:504-885-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96106207Q00000X
LAMD.201181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1064483Medicaid
FL84-1717599OtherEIN
LA1064483Medicaid