Provider Demographics
NPI:1154326999
Name:CARAVELLA, LOUIS P (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:P
Last Name:CARAVELLA
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 1:21375 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2122
Mailing Address - Country:US
Mailing Address - Phone:440-333-7346
Mailing Address - Fax:440-333-0273
Practice Address - Street 1:21375 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2122
Practice Address - Country:US
Practice Address - Phone:440-333-7346
Practice Address - Fax:440-333-0273
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH038275207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000027590OtherANTHEM
OH08-01175OtherUNITED HEALTHCARE
OH0826931Medicaid
OH0004007057OtherAETNA
OHF38275OtherAPEX
OH0417793Medicare PIN
OHF38275OtherAPEX