Basic Information
| Provider Information | |||||||||
| NPI: | 1568415222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUGHRAN MEDICAL GROUP, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3411 SILVERSIDE RD | ||||||||
| Address2: | WEBSTER BLDG, SUITE 103 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198104812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024798464 | ||||||||
| FaxNumber: | 3024798463 | ||||||||
| Practice Location | |||||||||
| Address1: | 3411 SILVERSIDE RD | ||||||||
| Address2: | WEBSTER BLDG, SUITE 103 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198104812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024798464 | ||||||||
| FaxNumber: | 3024798463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 12/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | LOUGHRAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3024798464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C10003043 | DE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.