Healthcare Provider Details

I. General information

NPI: 1619977253
Provider Name (Legal Business Name): DAVID E MCLOUGHLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR SUITE 301
DAYTON OH
45406-1830
US

IV. Provider business mailing address

803 PARK HILL CT
BEAVERCREEK OH
45430-1464
US

V. Phone/Fax

Practice location:
  • Phone: 937-279-9777
  • Fax: 937-279-9332
Mailing address:
  • Phone: 937-279-9777
  • Fax: 937-279-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35-084126
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: