Provider Demographics
NPI:1104814763
Name:BURSTAIN, TODD L (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:L
Last Name:BURSTAIN
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1401 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2426
Practice Address - Country:US
Practice Address - Phone:504-842-4747
Practice Address - Fax:504-842-1242
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33655207R00000X
LAMD207717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0218487Medicaid
IA22861OtherWELLMARK BCBS
LA2422391Medicaid
MS08908064Medicaid
IA0218487Medicaid
LA505609YH3UMedicare PIN
IAI0250Medicare PIN
LA2422391Medicaid