=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164604328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUIS N CARIDEO MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 07/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 808 BATTLEFIELD BLVD S
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-482-4721
-----------------------------------------------------
Fax | 757-482-9108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 BATTLEFIELD BLVD S
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-482-4721
-----------------------------------------------------
Fax | 757-482-9108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LOUIS N CARIDEO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 757-482-4721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------