Provider Demographics
NPI:1265477855
Name:MAHFOUZ, ANDREA I (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:I
Last Name:MAHFOUZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:STE S-750
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:STE S-750
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-340-6976
Practice Address - Fax:504-349-6786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAA10620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
32199OtherCDS
MM1226643OtherDEA
MM1226643OtherDEA