Provider Demographics
NPI:1710913975
Name:GILES, HENRY WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WADE
Last Name:GILES
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 1:1514 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:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3470
Practice Address - Fax:504-842-7372
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS164952085R0202X
LAMD.0222622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00462206OtherRAILROAD MEDICARE
MSP01198273OtherRAILROAD MEDICARE PTAN
AL157007Medicaid
MS00121180Medicaid
MS300104394OtherRAILROAD MEDICARE
MS512G700003OtherMS MEDICARE - GROUP
MS300000572Medicare ID - Type Unspecified
MS00121180Medicaid
AL157007Medicaid
MSP00462206OtherRAILROAD MEDICARE
H04817Medicare UPIN