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General NPI Number Information
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NPI Number | 1881337905
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Entity Type | Individual
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Provider Name | BENJAMIN B LORETO
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Gender | Male
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Dates
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Enumeration Date | 04/16/2022
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 15 E FREDERICK ST
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City | WALKERSVILLE
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State | MD
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Zip | 21793-8234
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Country | US
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Telephone | 240-215-6310
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W 7TH ST
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City | FREDERICK
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State | MD
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Zip | 21701-4506
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Country | US
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Telephone | 240-215-6310
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C08982
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License Number State | MD
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