Healthcare Provider Details

I. General information

NPI: 1144317140
Provider Name (Legal Business Name): KEITH J LOUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH-HITCHCOCK MEDICAL CENTER
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH-HITCHCOCK MEDICAL CENTER
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9850
  • Fax: 603-650-0910
Mailing address:
  • Phone: 603-653-9850
  • Fax: 603-650-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35-084751
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number35-084751
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15035
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number15035
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number15035
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: