=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659358232
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH LOUGHRAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2005
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3411 SILVERSIDE RD WEBSTER BUILDING, SUITE 103
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-479-8464
-----------------------------------------------------
Fax | 302-479-8463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 292 LONGVIEW LN
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-1752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-479-8464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | C10002436
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------