Provider Demographics
NPI: | 1386731024 |
---|---|
Name: | ARENA, LOUIS WILLIAM (PA-C) |
Entity type: | Individual |
Prefix: | MR |
First Name: | LOUIS |
Middle Name: | WILLIAM |
Last Name: | ARENA |
Suffix: | |
Gender: | M |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 601 WELDIN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | WILMINGTON |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19803-4941 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-494-1968 |
Mailing Address - Fax: | 302-764-3735 |
Practice Address - Street 1: | 601 WELDIN RD |
Practice Address - Street 2: | |
Practice Address - City: | WILMINGTON |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19803-4941 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-494-1968 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-06 |
Last Update Date: | 2019-04-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DE | C50000540 | 363A00000X |
363AS0400X, 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |