Provider Demographics
NPI:1871589689
Name:WASSERMAN, LOUIS A (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:WASSERMAN
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 1:6101 PINE RIDGE RD
Mailing Address - Street 2:1ST FLOOR DESK 12/13
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-263-0849
Mailing Address - Fax:239-263-2376
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:1ST FLOOR DESK 12/13
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-263-0849
Practice Address - Fax:239-263-2376
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115722207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14XV6OtherBCBS
FLHZ719ZMedicare PIN
B81207Medicare UPIN