Provider Demographics
NPI:1659551414
Name:BERNARD A LANDRY, MD, LLC
Entity Type:Organization
Organization Name:BERNARD A LANDRY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:ALDRICH
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-615-0799
Mailing Address - Street 1:19 KILLDEER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-4512
Mailing Address - Country:US
Mailing Address - Phone:504-722-5500
Mailing Address - Fax:
Practice Address - Street 1:3434 HOUMA BLVD STE 300A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4200
Practice Address - Country:US
Practice Address - Phone:504-454-9496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD-0182442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1452726Medicaid
LA5CM33Medicare PIN