1497945901 NPI number — DR. RYAN M KRLIN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497945901 NPI number — DR. RYAN M KRLIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRLIN
Provider First Name:
RYAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497945901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1542 TULANE AVE
Provider Second Line Business Mailing Address:
LSU DEPT OF UROLOGY, RM 547
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-568-2207
Provider Business Mailing Address Fax Number:
504-568-3990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 HOUMA BLVD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-4310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-412-1600
Provider Business Practice Location Address Fax Number:
504-412-1626
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD.201386 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 35.094859 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2088F0040X , with the licence number: MD.201386 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1077488 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3080311 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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