Provider Demographics
NPI:1306037486
Name:WASHINGTON, KEVIN LADARIUS SR (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LADARIUS
Last Name:WASHINGTON
Suffix:SR
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 1:5112 CRESCENT COVE LN
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7622
Mailing Address - Country:US
Mailing Address - Phone:770-378-0942
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAVIER ST
Practice Address - Street 2:7TH FLOOR SUITE D
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2272
Practice Address - Country:US
Practice Address - Phone:504-903-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201632207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine