Individual
MR. PRAMOD VIJAYAGOPAL MENON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
39 STARBRUSH CIR, COVINGTON, LA 70433-7304
(985) 871-4155
(985) 871-4483
Mailing address
1810 LINDBERG DR STE 2100, SLIDELL, LA 70458-8064
(985) 273-5027
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
14635R
LA
207RI0011X
Interventional Cardiology Physician
Primary
036175151
IL
207RI0011X
Interventional Cardiology Physician
14635R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1055841
—
LA
01
—
P00363789
RAILROAD MEDICARE
LA
Enumeration date
04/26/2006
Last updated
09/17/2025
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