Healthcare Provider Details

I. General information

NPI: 1215205380
Provider Name (Legal Business Name): JESSE O. LOIURIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY ST SHAPIRO 7, SUITE C
BOSTON MA
02118
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8992
  • Fax: 617-638-8979
Mailing address:
  • Phone: 617-414-5405
  • Fax: 617-414-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4276
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: