MEDICARE: DR. MARCUS H LOO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	159685	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053315614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS H LOO M.D.

Provider Business Mailing Address
First Line	:	254 CANAL ST
Second Line	:	SUITE 3001
City	:	NEW YORK
State	:	NY
Zip	:	10013-3501
Country	:	US
Telephone Number	:	212-925-8388
Fax Number	:	212-941-7426

Provider Business Practice Location Address
First Line	:	254 CANAL STREET
Second Line	:	SUITE 3001
City	:	NEW YORK
State	:	NY
Zip	:	10013-3501
Country	:	US
Telephone Number	:	212-925-8388
Fax Number	:	212-941-7426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/07/2009

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