Provider Demographics
NPI:1255331039
Name:MONTELARO, LOUIS VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:VICTOR
Last Name:MONTELARO
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 1:310 DUREL DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-2973
Mailing Address - Country:US
Mailing Address - Phone:225-713-2400
Mailing Address - Fax:224-713-2410
Practice Address - Street 1:310 DUREL DR
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2973
Practice Address - Country:US
Practice Address - Phone:225-713-2400
Practice Address - Fax:224-713-2410
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA010052839OtherRAILROAD MEDICARE
LA193856OtherMEDICARE GROUP # FOR RURAL HEALTH
LA1109941Medicaid
LAB64324Medicare UPIN
LA53037D279Medicare PIN