Prem Menon MD a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

07041R Issued in LA

Legal business name

PREM MENON MD A MEDICAL CORPORATION

Practice address

5217 Flanders Dr
Baton Rouge, LA 70808-9169

Phone

(225) 766-6931

Fax

(225) 766-9413

NPI assigned

Dec 27, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Vimla Menon, M.D

Title

Co-Owner

Phone

(225) 766-6931

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1293408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293408000000",
    "number": "1790089274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5217 FLANDERS DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089169",
            "telephone_number": "225-766-6931",
            "fax_number": "225-766-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5217 FLANDERS DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089169",
            "telephone_number": "225-766-6931",
            "fax_number": "225-766-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREM MENON MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-27",
        "last_updated": "2010-12-27",
        "status": "A",
        "authorized_official_last_name": "MENON",
        "authorized_official_first_name": "VIMLA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "225-766-6931",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "07041R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1904953",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Baton Rouge, LA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2010; 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.