1528063401 NPI number — DR. PETER M LOESCHER M.D.

Table of content: DR. PETER M LOESCHER M.D. (NPI 1528063401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528063401 NPI number — DR. PETER M LOESCHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOESCHER
Provider First Name:
PETER
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528063401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 SHIPPEE LANE
Provider Second Line Business Mailing Address:
SHARON HEALTH CENTER
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05065-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-763-8000
Provider Business Mailing Address Fax Number:
802-763-8090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 SHIPPEE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05065-0219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-763-8000
Provider Business Practice Location Address Fax Number:
802-763-8090
Provider Enumeration Date:
06/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  042-0010473 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QS0010X , with the licence number: 042-0010473 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1009155 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8000077 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: VN299401 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".