Provider Demographics
NPI:1982605572
Name:MACDONALD, LOUIS R (DPM)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 MONTAUK HWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1425
Mailing Address - Country:US
Mailing Address - Phone:631-878-3330
Mailing Address - Fax:631-878-3331
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1425
Practice Address - Country:US
Practice Address - Phone:631-878-3330
Practice Address - Fax:631-878-3331
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5424213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043209Medicaid
PG5642Medicare PIN
NY02043209Medicaid