Provider Demographics
NPI:1073554010
Name:GRECO-ANGELOPOULOS, GINA LUISA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA LUISA
Middle Name:
Last Name:GRECO-ANGELOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA LUISA
Other - Middle Name:
Other - Last Name:ANGELOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2640 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2640 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5912
Practice Address - Country:US
Practice Address - Phone:815-713-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187186207PE0004X
LAMD.205378207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
F53347Medicare UPIN