Basic Information
| Provider Information | |||||||||
| NPI: | 1962463893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDHAUS | ||||||||
| FirstName: | LOUISE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET12 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088532716 | ||||||||
| FaxNumber: | 5088540479 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952855 | ||||||||
| FaxNumber: | 5084255656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 47491 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 26809 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 7600436 | 01 | CIGNA HEALTH PLAN | OTHER | J04437 | 01 | BLUE SHIELD HMO BLUE | OTHER | J04437 | 01 | BLUE SHIELD INDEMNITY | OTHER | AA2148 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J04437 | 01 | BLUE CARE ELECT | OTHER | 3099415 | 01 | WELFARE | OTHER | 3099415 | 05 | MA | MEDICAID | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 1150049 | 01 | FIRST HEALTH | OTHER | 26809 | 01 | HEALTHY START | OTHER | 784214 | 01 | MVP HEALTH CARE | OTHER | 7894344 | 01 | AETNA US HEALTHCARE | OTHER | 9900043 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 1600211 | 01 | EVERCARE | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER |