Provider Demographics
NPI:1841384120
Name:VENDITTO, ALEGRA NICHOLE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEGRA
Middle Name:NICHOLE
Last Name:VENDITTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE
Mailing Address - Street 2:SL-16
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-7518
Mailing Address - Fax:504-988-8252
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:HC-62
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-1001
Practice Address - Fax:504-988-1005
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1424943Medicaid
LA4F051Medicare PIN
LAH81622Medicare UPIN