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General NPI Number Information
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NPI Number | 1114922077
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Entity Type | Individual
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Provider Name | LUIS F. OLMEDO MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 817 VOLVO PKWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2855
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Country | US
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Telephone | 757-668-4630
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Fax |
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Provider Business Mailing Address
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Address Line | 817 VOLVO PKWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2855
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Country | US
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Telephone | 757-668-4630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 6155
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 6155
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 0101255330
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101255330
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License Number State | VA
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