Provider Demographics
NPI:1811978455
Name:TARTAGLIA, LOUIS ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:ANTHONY
Last Name:TARTAGLIA
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 1:1661 HOLLAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-843-7800
Mailing Address - Fax:419-843-3444
Practice Address - Street 1:1661 HOLLAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-843-7800
Practice Address - Fax:419-843-3444
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0695542084P0800X
OH350695542084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2620426Medicaid
OHP00261162OtherMEDICARE RAILRAOD
OHA64122Medicare UPIN
OH4160551Medicare PIN