Individual
MR. VASANTH KUMAR BETHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1051 GAUSE BLVD., SUITE 230, SLIDELL, LA 70458
(985) 641-7577
(985) 643-0826
Mailing address
1514 JEFFERSON HWY., NEW ORLEANS, LA 70121
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
09114R
LA
207RC0000X
Cardiovascular Disease Physician
13115
MS
207RI0011X
Interventional Cardiology Physician
Primary
09114R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110414
—
MS
01
—
060018918
RAILROAD MEDICARE
—
05
—
1930636
—
LA
Enumeration date
05/31/2005
Last updated
04/13/2023
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