Provider Demographics
NPI:1063976215
Name:ABUSSADA, RAME
Entity type:Individual
Prefix:
First Name:RAME
Middle Name:
Last Name:ABUSSADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FAIRGROUNDS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6200
Mailing Address - Country:US
Mailing Address - Phone:225-288-5523
Mailing Address - Fax:
Practice Address - Street 1:5916 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5643
Practice Address - Country:US
Practice Address - Phone:337-988-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7998758172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver