Provider Demographics
NPI:1518254010
Name:RAVEENDRAN, KRISTINA V (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:V
Last Name:RAVEENDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:524-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:SUITE 890
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-842-4960
Practice Address - Fax:504-842-4251
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060532207Q00000X
LAMD.206906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01001734Medicaid
LA2368702Medicaid
LA362471YH3UMedicare PIN