Provider Demographics
NPI:1861508780
Name:DIMITRIADES, CONSTANTINE (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:DIMITRIADES
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 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-896-4800
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL - GENERAL PEDIATRICS
Practice Address - Street 2:200 HENRY CLAY AVENUE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024167208000000X
LAMD4193052080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1489336Medicaid
LA4J895Medicare PIN
I40337Medicare UPIN
LA4J895F669Medicare PIN