Provider Demographics
NPI:1518949544
Name:GUALDONI, LOUIS PAUL (PAC)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:PAUL
Last Name:GUALDONI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277730
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7730
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:SUITE 1310
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-776-2020
Practice Address - Fax:540-776-2017
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840653363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00453910OtherRAILROAD MEDICARE
VA010400856Medicaid
VAP00413634Medicare PIN
012759C65Medicare PIN
VAP00453910OtherRAILROAD MEDICARE
970000113Medicare ID - Type Unspecified