Provider Demographics
NPI:1306949995
Name:COMPETIELLO, LOUIS S (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:S
Last Name:COMPETIELLO
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 1:139 HAZARD AVENUE
Mailing Address - Street 2:BLDG 1 STE 3
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-763-3434
Mailing Address - Fax:860-749-7111
Practice Address - Street 1:139 HAZARD AVENUE
Practice Address - Street 2:BLDG 1 STE 3
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-3434
Practice Address - Fax:860-749-7111
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029022207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010029022CR01OtherBC/BS
E47462Medicare UPIN
CT010029022CR01OtherBC/BS
CTRR10000239Medicare ID - Type Unspecified