Provider Demographics
NPI:1033112610
Name:LOUGHERY, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:LOUGHERY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:480 MAPLE STREET
Mailing Address - Street 2:NORTHEAST CARDIOLOGY
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-304-8360
Mailing Address - Fax:978-304-8320
Practice Address - Street 1:480 MAPLE STREET
Practice Address - Street 2:NORTHEAST CARDIOLOGY
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-304-8360
Practice Address - Fax:978-304-8320
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2019-01-07
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Provider Licenses
StateLicense IDTaxonomies
MA238620207RI0011X
OH35061363L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001203701Medicare PIN
OHE46743Medicare UPIN
OHLO0694983Medicare ID - Type Unspecified
OH0837858Medicaid