Provider Demographics
NPI:1518929637
Name:MAGGIO, LOUIS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ANTHONY
Last Name:MAGGIO
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 1:340 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2401
Mailing Address - Country:US
Mailing Address - Phone:781-849-1111
Mailing Address - Fax:781-794-2288
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:781-849-1111
Practice Address - Fax:781-794-2288
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA69720OtherHARVARD PILGRIM NUMBER
MA0401785OtherUNITED HEALTHCARE #
MA3144062Medicaid
MAJ16303OtherBLUE SHIELD NUMBER
MA081562OtherTUFTS NUMBER
MAB10338501OtherCIGNA NUMBER
MA3144062Medicaid
MAG11322Medicare UPIN