Provider Demographics
NPI:1619952017
Name:ROLSTON, WILLIAM AIRTH III (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:AIRTH
Last Name:ROLSTON
Suffix:III
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 #450A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-454-9006
Mailing Address - Fax:504-456-5080
Practice Address - Street 1:4224 HOUMA BLVD #450A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-454-9006
Practice Address - Fax:504-456-5080
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD011699207RC0000X
LA11699207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1191205Medicaid
B61041Medicare UPIN
5K7826696Medicare Oscar/Certification