Healthcare Provider Details

I. General information

NPI: 1558470740
Provider Name (Legal Business Name): DAVID J. LONEY C.P., B.O.C.(O)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HANOVER ST STE 3A
LEBANON NH
03766-1020
US

IV. Provider business mailing address

190 HANOVER ST STE 3A
LEBANON NH
03766-1020
US

V. Phone/Fax

Practice location:
  • Phone: 603-252-6561
  • Fax: 603-443-9972
Mailing address:
  • Phone: 603-381-6561
  • Fax: 603-443-9972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: