Basic Information
Provider Information
NPI: 1104010511
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOFTON
FirstName: HOLLY
MiddleName: F.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178223034
CountryCode: US
TelephoneNumber: 5702716144
FaxNumber: 5702716578
Practice Location
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178222111
CountryCode: US
TelephoneNumber: 5702716439
FaxNumber: 5702716852
Other Information
ProviderEnumerationDate: 08/29/2007
LastUpdateDate: 02/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XMD432625PAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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