MEDICARE: DR. PATSY J 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	0101019495	VA
2	207U00000X	Nuclear Medicine Physician	0101019495	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25040	OTHER	VA	OPTIMA
2	139178	OTHER	VA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	25040	OTHER	VA	SENTARA

General Provider Information

NPI Number	:	1770567950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATSY J LOIACONO MD

Provider Business Mailing Address
First Line	:	6330 N CENTER DR
Second Line	:	BUILDING 13 STE 220
City	:	NORFOLK
State	:	VA
Zip	:	23502-4008
Country	:	US
Telephone Number	:	757-466-0089
Fax Number	:	757-466-8017

Provider Business Practice Location Address
First Line	:	6330 N CENTER DR
Second Line	:	BUILDING 13 STE 220
City	:	NORFOLK
State	:	VA
Zip	:	23502-4008
Country	:	US
Telephone Number	:	757-466-0089
Fax Number	:	757-466-8017

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	02/28/2008

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Directions to “ DR. PATSY J LOIACONO MD” Practice Location

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