MEDICARE: DR. LOUIS JOHN DALESSANDRO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	9400037	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	660001575	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407843808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS JOHN DALESSANDRO D.O.

Provider Business Mailing Address
First Line	:	2240 REMOUNT RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-4725
Country	:	US
Telephone Number	:	704-671-5311
Fax Number	:	704-671-5308

Provider Business Practice Location Address
First Line	:	2711 X RAY DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-7491
Country	:	US
Telephone Number	:	704-671-6438
Fax Number	:	704-671-6436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	10/19/2007

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Directions to “ DR. LOUIS JOHN DALESSANDRO D.O.” Practice Location

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