Provider Demographics
NPI:1982663340
Name:AWASTHI, DEEPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:AWASTHI
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:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-447-2645
Mailing Address - Fax:985-447-2604
Practice Address - Street 1:604 N ACADIA RD
Practice Address - Street 2:SUITE 410
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-447-2645
Practice Address - Fax:985-447-2604
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL07590R174400000X
LAMD.07590R207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925888Medicaid
LA5N881DR34Medicare PIN
LAF19144Medicare UPIN
LA5N881Medicare ID - Type Unspecified