Provider Demographics
NPI:1649738618
Name:DIGIOVINE, LOUIS TAYLOR (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:TAYLOR
Last Name:DIGIOVINE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CHARLES VIEW WAY APT D
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2111
Mailing Address - Country:US
Mailing Address - Phone:908-963-1062
Mailing Address - Fax:
Practice Address - Street 1:11 SOUTHFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:POTTERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07979
Practice Address - Country:US
Practice Address - Phone:908-963-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty