Healthcare Provider Details

I. General information

NPI: 1477648582
Provider Name (Legal Business Name): JOHN M. O'LOUGHLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ERDMAN WAY SUITE 315.
LEOMINSTER MA
01453
US

IV. Provider business mailing address

80 ERDMAN WAY SUITE 315.
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-4805
  • Fax: 978-537-2185
Mailing address:
  • Phone: 978-537-4805
  • Fax: 978-537-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number28368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: