Provider Demographics
NPI:1427078500
Name:IANNIELLO, LOUIS C (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:C
Last Name:IANNIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3700
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-346-9682
Practice Address - Fax:518-346-9693
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY189423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46546OtherGHI/HMO
NY691811OtherEMPIRE BC
NY10000940OtherCDPHP
NY08221OtherMVP
NY070126000024OtherFIDELIS
NY4320384OtherAETNA
NY200125OtherSENIOR WHOLE HEALTH
NY01463441Medicaid
NY000401166001OtherBSNENY
NY10000940OtherCDPHP
NYF35675Medicare UPIN