Provider Demographics
NPI:1033739529
Name:LOFTUS, MAUREEN MARGUERITE (BCCS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MARGUERITE
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:BCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8321 OLD COURTHOUSE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3817
Mailing Address - Country:US
Mailing Address - Phone:703-462-9570
Mailing Address - Fax:703-890-1498
Practice Address - Street 1:8321 OLD COURTHOUSE RD STE 130
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3817
Practice Address - Country:US
Practice Address - Phone:703-462-9570
Practice Address - Fax:703-890-1498
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist