1003919051 NPI number — PETER LOIACONO

Table of content: (NPI 1659579092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003919051 NPI number — PETER LOIACONO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOIACONO
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1003919051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTERFIELD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03466-0541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-257-7785
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 ROXBURY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-499-1775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

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: 101YA0400X , with the licence number:  000151 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000151 . This is a "VERMONT ALCOHOL AND DRUG COUNSELOR CERTIFICATION BOARD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0588 . This is a "NEW HAMPSHIRE BOARD OF ALCOHOL &OTHER DRUG ABUSE PROFESSIONAL PRACTICE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2221 . This is a "MASSACHUSETTS BUREAU OF SUBSTANCE ABUSE SERVICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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