Provider Demographics
NPI:1245243955
Name:OLEGARIO, LOUIS (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:OLEGARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LOUIS
Other - Middle Name:TEODORICO RADA
Other - Last Name:OLEGARIO V
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4243 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3600
Mailing Address - Country:US
Mailing Address - Phone:800-735-1178
Mailing Address - Fax:772-223-6354
Practice Address - Street 1:4243 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3600
Practice Address - Country:US
Practice Address - Phone:800-735-1178
Practice Address - Fax:772-223-6354
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4191662081P2900X
FLME1155092081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058664S8LOtherMEDICARE
FL117176500Medicaid
PA0018945060001Medicaid
PA083896OtherMEDICARE GROUP