Provider Demographics
NPI:1962412056
Name:DOROSTKAR, PARVIN CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:PARVIN
Middle Name:CHRISTINE
Last Name:DOROSTKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PARVIN
Other - Middle Name:D
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5798
Mailing Address - Country:US
Mailing Address - Phone:504-899-9511
Mailing Address - Fax:
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5798
Practice Address - Country:US
Practice Address - Phone:504-899-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-019352080P0203X
MN513422080P0203X
VA01012687052080P0203X
NV170002080P0203X
LA3303912080P0203X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147493OtherANTHEM
LA2604864Medicaid
UT1962412056Medicaid
OH0919251Medicaid