Provider Demographics
NPI:1215246517
Name:PARAMOUNT MEDICAL SERVICES OF LOUISIANA, L.L.C.
Entity type:Organization
Organization Name:PARAMOUNT MEDICAL SERVICES OF LOUISIANA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:MALLAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-494-3803
Mailing Address - Street 1:339 WORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4242 HIGHWAY 19
Practice Address - Street 2:SUITE A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3910
Practice Address - Country:US
Practice Address - Phone:914-494-3803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD013361207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty