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NPI Code Detail

MEDICARE: DR. GARY BLAINE LODEN M.D.

MEDICARE: DR. GARY BLAINE LODEN 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
1208800000XUrology Physician230013NY

Other Identifiers

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

General Provider Information

NPI Number : 1598771529
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY BLAINE LODEN M.D.
Provider Business Mailing Address
First Line : 155 CRYSTAL RUN RD
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10941-4028
Country : US
Telephone Number : 845-703-6999
Fax Number : 845-703-6297
Provider Business Practice Location Address
First Line : 1200 ROUTE 300
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-5003
Country : US
Telephone Number : 845-703-6999
Fax Number : 845-703-6297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 10/09/2020

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