Provider Demographics
NPI:1275649618
Name:ANQUILO, LOUIE A (MD)
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:A
Last Name:ANQUILO
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14214 BALLANTYNE LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3372
Practice Address - Country:US
Practice Address - Phone:704-667-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01015207Q00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910325Medicaid
NC1275649618Medicaid
SC313244Medicaid
PAMD429730OtherPENNSYLVANIA LICENSE NUMB
NC2022924HMedicare PIN
NC2022924FMedicare PIN
SCAA34077772Medicare PIN
NCNC4723BMedicare PIN
NC2022924KMedicare PIN
NCNC4723AMedicare PIN
NC2022924BMedicare PIN
NC2022924AMedicare PIN
NC2022924Medicare PIN
NC1275649618Medicaid
NC2022924LMedicare PIN
SC313244Medicaid
NCNC4723CMedicare PIN
NC2022924CMedicare PIN