Provider Demographics
NPI:1437101110
Name:CVITANOVICH, GERALD ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ANTHONY
Last Name:CVITANOVICH
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-914-6074
Mailing Address - Fax:504-831-3778
Practice Address - Street 1:708 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2736
Practice Address - Country:US
Practice Address - Phone:504-461-9660
Practice Address - Fax:504-461-8450
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019027207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443964Medicaid
LA54454Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LA1443964Medicaid