Provider Demographics
NPI:1811043201
Name:DANILYANTS, EDUARD VARTANOVICH
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:VARTANOVICH
Last Name:DANILYANTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 WILLS ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1132
Mailing Address - Country:US
Mailing Address - Phone:504-455-6145
Mailing Address - Fax:
Practice Address - Street 1:1401 FOUCHER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3515
Practice Address - Country:US
Practice Address - Phone:504-897-7732
Practice Address - Fax:504-897-7759
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023622207R00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1499315Medicaid
LA330999615OtherHUMANA
LA110239116OtherMCR RR
LAH03794Medicare UPIN
LA5E836Medicare ID - Type Unspecified