Healthcare Provider Details

I. General information

NPI: 1457311615
Provider Name (Legal Business Name): LOUIS J. DECARO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEST ST UNIT 7
WEST HATFIELD MA
01088-9554
US

IV. Provider business mailing address

10 WEST ST UNIT 7
WEST HATFIELD MA
01088-9554
US

V. Phone/Fax

Practice location:
  • Phone: 413-397-9890
  • Fax: 413-397-8899
Mailing address:
  • Phone: 413-397-9890
  • Fax: 413-397-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2161
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: