Healthcare Provider Details

I. General information

NPI: 1558621235
Provider Name (Legal Business Name): LOREN MILDRED FRANCES BABIRAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

32 MOUNTAIN RD
BIDDEFORD ME
04005-9402
US

V. Phone/Fax

Practice location:
  • Phone: 207-602-8195
  • Fax:
Mailing address:
  • Phone: 207-602-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMT210277
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: