Provider Demographics
NPI:1447208897
Name:D'AMELIO, LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:D'AMELIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-7211
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:609-815-7829
Mailing Address - Fax:
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-5247
Practice Address - Country:US
Practice Address - Phone:609-396-2600
Practice Address - Fax:609-396-3600
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05489300208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2218003Medicaid
NJ2218003Medicaid
NJ609179N9PMedicare PIN