Provider Demographics
NPI:1780994079
Name:C. EDWARD FOTI, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:C. EDWARD FOTI, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FOTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-250-1714
Mailing Address - Street 1:3106 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5406
Mailing Address - Country:US
Mailing Address - Phone:504-250-1714
Mailing Address - Fax:504-455-5751
Practice Address - Street 1:3106 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5406
Practice Address - Country:US
Practice Address - Phone:504-250-1714
Practice Address - Fax:504-455-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101662086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty