Provider Demographics
NPI:1356421606
Name:CONNOLLY, LOUISE H (MD)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:H
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2110 ARTESIA BLVD # 712
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3073
Mailing Address - Country:US
Mailing Address - Phone:310-372-4706
Mailing Address - Fax:310-798-7328
Practice Address - Street 1:510 N PROSPECT AVE STE 306
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3028
Practice Address - Country:US
Practice Address - Phone:310-372-4706
Practice Address - Fax:310-798-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51576Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID