Provider Demographics
NPI:1104891597
Name:CROTEAU, LOUIS J (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:CROTEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1024 FIRST COLONIAL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3074
Mailing Address - Country:US
Mailing Address - Phone:757-321-4030
Mailing Address - Fax:757-275-9700
Practice Address - Street 1:1024 FIRST COLONIAL RD
Practice Address - Street 2:STE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3074
Practice Address - Country:US
Practice Address - Phone:757-321-4030
Practice Address - Fax:757-275-9700
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101028812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005621437Medicaid
VA005621437Medicaid
B07024Medicare UPIN