Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | MD419166 | PA |
Y | 2081P2900X | Pain Medicine | ME115509 | FL |
NPI | 1245243955 |
---|---|
Provider Name | Louis Olegario |
First Address | Hunt Valley, MD 21031-3707 |
Second Address | Lady Lake, FL 32159-5027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018945060001 | (05) | PA |
058664S8L | MEDICARE (01) | PA |
083896 | MEDICARE GROUP (01) | PA |