Provider Demographics
NPI:1306165097
Name:TILTON, ANDRE DOMINICK (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:DOMINICK
Last Name:TILTON
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 1:6621 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2669
Mailing Address - Country:US
Mailing Address - Phone:504-309-7030
Mailing Address - Fax:
Practice Address - Street 1:4101 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6817
Practice Address - Country:US
Practice Address - Phone:504-446-1390
Practice Address - Fax:877-473-0040
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139441207Q00000X
NMMD2019-0172207Q00000X
NE28991207Q00000X
390200000X
LAMD.205203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01105572Medicaid
LA2111906Medicaid
MS01105572Medicaid