Provider Demographics
NPI:1922042860
Name:LE, VAN T (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4315 HOUMA BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2940
Mailing Address - Country:US
Mailing Address - Phone:504-889-5249
Mailing Address - Fax:504-889-5401
Practice Address - Street 1:4315 HOUMA BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2940
Practice Address - Country:US
Practice Address - Phone:504-889-5249
Practice Address - Fax:504-889-5401
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA07032R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51512Medicare ID - Type Unspecified