Provider Demographics
NPI:1013021930
Name:CARIDEO, LOUIS NICONDRO (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:NICONDRO
Last Name:CARIDEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S BATTLEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6611
Mailing Address - Country:US
Mailing Address - Phone:757-482-4721
Mailing Address - Fax:757-546-9108
Practice Address - Street 1:808 S BATTLEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6611
Practice Address - Country:US
Practice Address - Phone:757-482-4721
Practice Address - Fax:757-546-9108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B08504Medicare UPIN
VA00V082L28Medicare PIN