Provider Demographics
NPI:1669558920
Name:KANDAVAR, RAMPRASAD (MD)
Entity type:Individual
Prefix:DR
First Name:RAMPRASAD
Middle Name:
Last Name:KANDAVAR
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 1:711 WOOD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7564
Mailing Address - Country:US
Mailing Address - Phone:504-988-7518
Mailing Address - Fax:504-988-7144
Practice Address - Street 1:1415 TULANE AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-988-2300
Practice Address - Fax:504-988-7144
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201168207RN0300X
LA201168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408409Medicaid
LA1408409Medicaid
LA4K464Medicare PIN