Healthcare Provider Details

I. General information

NPI: 1740248202
Provider Name (Legal Business Name): ANDREAS W LOEPKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S 34TH STREET SUITE 9329
PHILADELPHIA PA
19104-4399
US

IV. Provider business mailing address

THE WANAMAKER BLDG., 9TH FL, N 100 EAST PENN SQUARE
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1867
  • Fax:
Mailing address:
  • Phone: 267-425-9320
  • Fax: 267-425-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.08238
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35.082380
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD067951L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: