Provider Demographics
NPI:1407926488
Name:FATTEL, IDA F (MD)
Entity Type:Individual
Prefix:DR
First Name:IDA
Middle Name:F
Last Name:FATTEL
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 1:922 OCTAVIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3125
Mailing Address - Country:US
Mailing Address - Phone:504-891-9711
Mailing Address - Fax:866-686-7691
Practice Address - Street 1:1401 FOUCHER ST
Practice Address - Street 2:WOUND CARE CENTER
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3515
Practice Address - Country:US
Practice Address - Phone:504-897-7732
Practice Address - Fax:504-897-7759
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1154547Medicaid