Provider Demographics
NPI:1609821917
Name:PATSEAVOURAS, LOUIE LEE (MD)
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:LEE
Last Name:PATSEAVOURAS
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 1:522 N ELAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1100
Mailing Address - Country:US
Mailing Address - Phone:336-299-4907
Mailing Address - Fax:336-292-9423
Practice Address - Street 1:522 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1151
Practice Address - Country:US
Practice Address - Phone:336-299-4907
Practice Address - Fax:336-292-9423
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC89518Medicare UPIN
NC209452Medicare ID - Type Unspecified