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General NPI Number Information
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NPI Number | 1063071371
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Entity Type | Individual
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Provider Name | SEAN LOOSE MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 535 S OXFORD VALLEY RD
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City | FAIRLESS HILLS
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State | PA
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Zip | 19030-2612
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Country | US
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Telephone | 215-946-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 535 S OXFORD VALLEY RD
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City | FAIRLESS HILLS
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State | PA
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Zip | 19030-2612
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Country | US
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Telephone | 215-946-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD477020
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MD477020
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License Number State | PA
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