Basic Information
| Provider Information | |||||||||
| NPI: | 1033397443 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TOLBA | ||||||||
| FirstName: | REDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 W ESPLANADE AVE | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044648588 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1514 JEFFERSON HWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2008 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 57.012996 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MD.205494 | LA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03736500 | 05 | LA | MEDICAID | 2319132 | 05 | LA | MEDICAID |