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NPI Code Detail

MEDICARE: PETER LOFASO MD

MEDICARE: PETER LOFASO 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
1207Q00000XFamily Medicine Physician159393NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942201496
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER LOFASO MD
Provider Business Mailing Address
First Line : 346 GRAND AVE
Second Line :
City : JOHNSON CITY
State : NY
Zip : 13790-2558
Country : US
Telephone Number : 607-754-7171
Fax Number : 607-754-0290
Provider Business Practice Location Address
First Line : 1302 E MAIN ST
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5430
Country : US
Telephone Number : 607-754-7171
Fax Number : 607-754-0290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 10/08/2013

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Directions to “ PETER LOFASO MD” Practice Location

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