MEDICARE: DR. ANDREW PATRICK LOIACONO MD

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	2085R0202X	Diagnostic Radiology Physician	223586	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468281	OTHER	MA	TUFTS HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	J28599	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1437140050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW PATRICK LOIACONO MD

Provider Business Mailing Address
First Line	:	110 KINGSLEY LN
Second Line	:	SUITE 305
City	:	NORFOLK
State	:	VA
Zip	:	23505-4614
Country	:	US
Telephone Number	:	757-889-5422
Fax Number	:	757-889-5450

Provider Business Practice Location Address
First Line	:	110 KINGSLEY LN
Second Line	:	SUITE 305
City	:	NORFOLK
State	:	VA
Zip	:	23505-4614
Country	:	US
Telephone Number	:	757-889-5422
Fax Number	:	757-889-5450

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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