Provider Demographics
NPI:1295790723
Name:ABDOLREZA VADIEE, INC.
Entity type:Organization
Organization Name:ABDOLREZA VADIEE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDOLREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VADIEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:504-278-1414
Mailing Address - Street 1:125 E SAINT BERNARD HWY
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-5159
Mailing Address - Country:US
Mailing Address - Phone:504-278-1414
Mailing Address - Fax:504-278-1455
Practice Address - Street 1:125 E SAINT BERNARD HWY
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5159
Practice Address - Country:US
Practice Address - Phone:504-278-1414
Practice Address - Fax:504-278-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2018-10-31
Deactivation Date:2018-05-15
Deactivation Code:
Reactivation Date:2018-10-31
Provider Licenses
StateLicense IDTaxonomies
LA023512208D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447617Medicaid
LA5CT79Medicare PIN
LA5C827Medicare PIN