Provider Demographics
NPI:1972597003
Name:COLAVECCHIO, LOUIS VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:VINCENT
Last Name:COLAVECCHIO
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 1:360 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3239
Mailing Address - Country:US
Mailing Address - Phone:401-789-9911
Mailing Address - Fax:401-789-3106
Practice Address - Street 1:360 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3239
Practice Address - Country:US
Practice Address - Phone:401-789-9911
Practice Address - Fax:401-789-3106
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5440207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0300142OtherUNITED HEALTHCARE
RILC00179Medicaid
RI766-1OtherBLUE CROSS BLUE SHIELD
RI000491OtherBLUE CHIP
RILC00179Medicaid