Provider Demographics
NPI:1023259090
Name:TARANTO, KATIE BRILLHART (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:BRILLHART
Last Name:TARANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:BRILLHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:80 GARDENIA DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-871-5900
Mailing Address - Fax:985-871-5911
Practice Address - Street 1:80 GARDENIA DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-871-5900
Practice Address - Fax:985-871-5911
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.203881207R00000X
LA203881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
4R019Medicare UPIN