Provider Demographics
NPI:1437730827
Name:MUSTAFA, MAJD (MD)
Entity type:Individual
Prefix:MR
First Name:MAJD
Middle Name:
Last Name:MUSTAFA
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 1:131 S. ROBERTSON ST, 12TH FLOOR, MAIL CODE 8069
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112
Mailing Address - Country:US
Mailing Address - Phone:504-988-5314
Mailing Address - Fax:504-988-2684
Practice Address - Street 1:1415 TULANE AVENUE, 4TH FLOOR
Practice Address - Street 2:OPHTHALMOLOGY CLINIC
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-988-5314
Practice Address - Fax:504-988-2684
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA326544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1167819Medicaid