Provider Demographics
NPI:1063822567
Name:DIVILIO, LOUIS THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:THOMAS
Last Name:DIVILIO
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 1:28526 9TH DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8385
Mailing Address - Country:US
Mailing Address - Phone:410-822-3914
Mailing Address - Fax:
Practice Address - Street 1:28526 9TH DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-8385
Practice Address - Country:US
Practice Address - Phone:410-822-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery