Provider Demographics
NPI:1538329370
Name:DAVE, AMAR HARSHAD (MD)
Entity type:Individual
Prefix:DR
First Name:AMAR
Middle Name:HARSHAD
Last Name:DAVE
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 1:751 MIRABELLA LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-0882
Mailing Address - Country:US
Mailing Address - Phone:225-439-1946
Mailing Address - Fax:
Practice Address - Street 1:4245 WINBOURNE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-6062
Practice Address - Country:US
Practice Address - Phone:225-357-2248
Practice Address - Fax:225-357-0158
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.204628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1087254Medicaid