Provider Demographics
NPI:1801894100
Name:MEDVED, LOUIS HOWARD (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:HOWARD
Last Name:MEDVED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 ERIE CANAL DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4604
Mailing Address - Country:US
Mailing Address - Phone:585-227-3950
Mailing Address - Fax:585-227-3106
Practice Address - Street 1:30 ERIE CANAL DR
Practice Address - Street 2:SUITE G
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4604
Practice Address - Country:US
Practice Address - Phone:585-227-3950
Practice Address - Fax:585-227-9047
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1589412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10095BMedicare ID - Type Unspecified
E47289Medicare UPIN