Provider Demographics
NPI:1023076924
Name:HASELL, LOUISE CANTEY (MD)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:CANTEY
Last Name:HASELL
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 1:4038 RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5527
Mailing Address - Country:US
Mailing Address - Phone:740-353-3236
Mailing Address - Fax:740-353-4803
Practice Address - Street 1:4038 RHODES AVE
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5527
Practice Address - Country:US
Practice Address - Phone:740-353-3236
Practice Address - Fax:740-353-4801
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41245207R00000X
OH35070810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2002380Medicaid
OHP00373245OtherRR MEDICARE
KY64953771Medicaid
OH0812338Medicare PIN
KY3403681Medicare PIN
D21044Medicare UPIN
OH0812334Medicare PIN