Provider Demographics
NPI:1316280886
Name:INSALACO, LOUIS F (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:F
Last Name:INSALACO
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 1:41 MONTVALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2445
Mailing Address - Country:US
Mailing Address - Phone:781-279-0971
Mailing Address - Fax:
Practice Address - Street 1:41 MONTVALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2445
Practice Address - Country:US
Practice Address - Phone:781-279-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276414207YX0905X, 207YX0905X
MN63416207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1316280886Medicaid