Healthcare Provider Details

I. General information

NPI: 1770567950
Provider Name (Legal Business Name): PATSY J LOIACONO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 N CENTER DR BUILDING 13 STE 220
NORFOLK VA
23502-4008
US

IV. Provider business mailing address

6330 N CENTER DR BUILDING 13 STE 220
NORFOLK VA
23502-4008
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-0089
  • Fax: 757-466-8017
Mailing address:
  • Phone: 757-466-0089
  • Fax: 757-466-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101019495
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number0101019495
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: