Healthcare Provider Details

I. General information

NPI: 1639169709
Provider Name (Legal Business Name): LORETTA Y CHOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

C/O ST MARY'S HEALTH SYSTEM - PROVIDER ENROLLMENT PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-221-6728
Mailing address:
  • Phone: 77-778-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18720
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159489
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: