Provider Demographics
NPI:1568810521
Name:PANDIS, NICHOLAS THEODORE JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:THEODORE JOHN
Last Name:PANDIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:NICHOLAS
Other - Middle Name:THEODORE JOHN
Other - Last Name:PANIDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2633 NAPOLEON AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-7422
Mailing Address - Country:US
Mailing Address - Phone:504-897-9686
Mailing Address - Fax:504-899-9461
Practice Address - Street 1:2633 NAPOLEON AVE STE 500
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7422
Practice Address - Country:US
Practice Address - Phone:504-897-9686
Practice Address - Fax:504-899-9461
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant