Provider Demographics
NPI:1801958459
Name:VERARDO, LOUIS THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:THOMAS
Last Name:VERARDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 HAWTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1717
Mailing Address - Country:US
Mailing Address - Phone:631-754-1182
Mailing Address - Fax:
Practice Address - Street 1:181 BELLEMEADE RD
Practice Address - Street 2:STONYBROOK FAMMED PC
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3495
Practice Address - Country:US
Practice Address - Phone:631-444-5858
Practice Address - Fax:631-444-1899
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-10-20
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Provider Licenses
StateLicense IDTaxonomies
NY141828207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87548Medicare UPIN