Provider Demographics
NPI:1437133675
Name:TILTON, GREGORY D (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:D
Last Name:TILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 HOUMA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2938
Mailing Address - Country:US
Mailing Address - Phone:504-455-0842
Mailing Address - Fax:504-503-6737
Practice Address - Street 1:4224 HOUMA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2938
Practice Address - Country:US
Practice Address - Phone:504-455-0842
Practice Address - Fax:504-503-6737
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014901207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348015Medicaid
B26990Medicare UPIN
LA1348015Medicaid