Provider Demographics
NPI:1538363551
Name:LOUIS SPAGNOLETTI, M.D., LLC
Entity type:Organization
Organization Name:LOUIS SPAGNOLETTI, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAGNOLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-983-9001
Mailing Address - Street 1:GREENTREE EXECUTIVE CAMPUS
Mailing Address - Street 2:1001A LINCOLN DRIVE WEST
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:956-983-9001
Mailing Address - Fax:856-983-9011
Practice Address - Street 1:GREENTREE EXECUTIVE CAMPUS
Practice Address - Street 2:1001A LINCOLN DRIVE WEST
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:956-983-9001
Practice Address - Fax:856-983-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ008945Medicare ID - Type Unspecified