MEDICARE: DR. LORETTA A PRATT 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	207N00000X	Dermatology Physician	MD21694	ME
2	207N00000X	Dermatology Physician	1577481	NY
3	207N00000X	Dermatology Physician	MD038745E	PA

General Provider Information

NPI Number	:	1770583320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORETTA A PRATT MD

Provider Business Mailing Address
First Line	:	1850 E PARK AVE
Second Line	:	SUITE 312
City	:	STATE COLLEGE
State	:	PA
Zip	:	16803-6706
Country	:	US
Telephone Number	:	814-237-6600
Fax Number	:	814-237-5383

Provider Business Practice Location Address
First Line	:	1850 E PARK AVE
Second Line	:	SUITE 312
City	:	STATE COLLEGE
State	:	PA
Zip	:	16803-6706
Country	:	US
Telephone Number	:	814-237-6600
Fax Number	:	814-237-5383

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/12/2019

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