Provider Demographics
NPI:1376617928
Name:IVO BARONNE MD,MEDICAL CORPORATION
Entity Type:Organization
Organization Name:IVO BARONNE MD,MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVO
Authorized Official - Middle Name:
Authorized Official - Last Name:IATCHOVSKI-BARONNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-338-4042
Mailing Address - Street 1:1500 W ESPLANADE AVE
Mailing Address - Street 2:APT.C-45
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-5300
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:504-885-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty