Provider Demographics
NPI:1265472484
Name:LOUIS, MARIE E (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:110 MARTER AVENUE
Practice Address - Street 2:BLDG. 500 SUITE 503
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-608-8840
Practice Address - Fax:856-722-1898
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422927207Q00000X
NJMA84784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3947491OtherOXFORD
NJ0176991Medicaid
NJ60044554OtherHORIZON NJ HEALTH
NJ6638919/7921640OtherAETNA
NJ46918OtherUNIVERISTY HEALTH PLAN
NJ7891031OtherCIGNA
NJ7891031OtherCIGNA
PAI11646Medicare UPIN
NJ46918OtherUNIVERISTY HEALTH PLAN