NPIMap

Individual provider Active NPI

Vikram Khoshoo, MD

  • Pediatric Gastroenterology Physician
  • Marrero, LA
National Provider Identifier
1285620690
Registry record updated Oct 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
08776R Issued in LA
Practice address
1111 Medical Center Blvd
Suite South 650
Marrero, LA 70072-3151
Phone
(504) 349-6504
Fax
(504) 349-6528
NPI assigned
Sep 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 08776R LA Primary

Addresses

Primary practice location

1111 Medical Center Blvd
Suite South 650
Marrero, LA 70072-3151

Mailing address

1111 Medical Center Blvd
South 650, Attn: Heidi Gwinn
Marrero, LA 70072-3151
Phone (504) 349-1297

Other identifiers 1

IdentifierTypeStateIssuer
1922510MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255046400000",
    "number": "1285620690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SOUTH 650, ATTN: HEIDI GWINN",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-1297",
            "fax_number": "504-349-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "SUITE SOUTH 650",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-349-6504",
            "fax_number": "504-349-6528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOSHOO",
        "first_name": "VIKRAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2009-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "LA",
            "license": "08776R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922510",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.