Provider Demographics
NPI:1083797955
Name:LOFTON, RAYGAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYGAN
Middle Name:L
Last Name:LOFTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:24A MAGOTHY BEACH RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4428
Practice Address - Country:US
Practice Address - Phone:410-255-2700
Practice Address - Fax:410-437-1962
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208595OtherJHHC PRIORITY PARTNERS
MD8170793OtherMAMSI PRIMARY CARE
MD925556-01OtherCAREFIRST MD RENDERING PROVIDER NUMBER
MD7605-0093OtherCAREFIRST BLUECHOICE
MD1498393OtherCIGNA PIN
MD1604419OtherAETNA HMO
MDP00602813OtherRAILROAD MEDICARE
MD412709900Medicaid
MDP17925OtherCAREFIRST MPOS
MD2170793OtherMAMSI SPECIALIST
MD7554954OtherAETNA PPO
MD925556-01OtherCAREFIRST MD RENDERING PROVIDER NUMBER
MDQ632Medicare PIN