Provider Demographics
NPI:1982630075
Name:SWIATLO, EDWIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:SWIATLO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117
Mailing Address - Country:US
Mailing Address - Phone:504-821-2601
Mailing Address - Fax:504-814-6047
Practice Address - Street 1:1631 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117
Practice Address - Country:US
Practice Address - Phone:504-821-2601
Practice Address - Fax:504-814-6047
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15572207RI0200X
LA334371207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2620886Medicaid
MS0118725Medicaid
MSRR440002696OtherRAILROAD
E85777Medicare UPIN
MS302I448641Medicare PIN
MS512I440004Medicare PIN
MS0118725Medicaid