Provider Demographics
NPI:1538170055
Name:GEDALIA, ABRAHAM (MD)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:
Last Name:GEDALIA
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 1:200 HENRY CLAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-896-9385
Mailing Address - Fax:504-896-2720
Practice Address - Street 1:200 HENRY CLAY AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-2723
Practice Address - Fax:504-896-2720
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09014R208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110035Medicaid
LA00110035Medicaid
AL009960175Medicaid
LA1928453Medicaid
AL009960175Medicaid
F21976Medicare UPIN
LA1928453Medicaid
LA5N920Medicare UPIN