Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 13689 | MS |
Y | 2080P0210X | Pediatric Nephrologist | MD.05179R | LA |
NPI | 1710929187 |
---|---|
Provider Name | Radhakrishna Baliga |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 22/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00112700 | (05) | MS |
1305723 | (05) | LA |
B88939 | (02) | MS |