Provider Demographics
NPI:1962463893
Name:FELDHAUS, LOUISE E (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:E
Last Name:FELDHAUS
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 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-853-2716
Mailing Address - Fax:508-854-0479
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2855
Practice Address - Fax:508-425-5656
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA474912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
26809OtherCHILDRENS MEDICAL SECURIT
7600436OtherCIGNA HEALTH PLAN
J04437OtherBLUE SHIELD HMO BLUE
J04437OtherBLUE SHIELD INDEMNITY
AA2148OtherHARVARD PILGRIM HEALTHCAR
J04437OtherBLUE CARE ELECT
3099415OtherWELFARE
MA3099415Medicaid
042472266OtherPRIVATE HEALTHCARE SYSTEM
1150049OtherFIRST HEALTH
26809OtherHEALTHY START
784214OtherMVP HEALTH CARE
7894344OtherAETNA US HEALTHCARE
9900043OtherFALLON COMMUNITY HEALTH P
1600211OtherEVERCARE
042472266OtherONE HEALTH PLAN
1150049OtherFIRST HEALTH
1600211OtherEVERCARE
MAJ04437Medicare ID - Type Unspecified
J04437OtherBLUE SHIELD HMO BLUE