1306842125 NPI number — CAROL A LOEFFLER PHD

Table of content: CAROL A LOEFFLER PHD (NPI 1306842125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306842125 NPI number — CAROL A LOEFFLER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOEFFLER
Provider First Name:
CAROL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAYMAN
Provider Other First Name:
CAROL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306842125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER CENTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05255-9642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-867-7035
Provider Business Mailing Address Fax Number:
802-367-1069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER CENTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05255-9642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-867-7035
Provider Business Practice Location Address Fax Number:
802-367-1069
Provider Enumeration Date:
06/27/2005

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: 103T00000X , with the licence number:  5201 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 5201 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P620004623 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1024899 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281743 . This is a "TRICARE CHAMPUS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5949417 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 03818 . This is a "PARAMOUNT HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2015796 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271070000 . This is a "MAGELLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000325622 . This is a "ANTHEM BC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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