Healthcare Provider Details

I. General information

NPI: 1154950251
Provider Name (Legal Business Name): CALEB LOUGHEED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ST PAUL DR
CHAMBERSBURG PA
17201-1036
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-264-6511
  • Fax: 717-264-9077
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS022410
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: