Provider Demographics
NPI:1144229303
Name:LOFTON, AZIEB G (DO)
Entity Type:Individual
Prefix:
First Name:AZIEB
Middle Name:G
Last Name:LOFTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AZIEB
Other - Middle Name:
Other - Last Name:GHEBREMEDHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:600 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-2413
Mailing Address - Country:US
Mailing Address - Phone:856-845-4061
Mailing Address - Fax:856-384-1770
Practice Address - Street 1:600 JESSUP RD
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08066-2413
Practice Address - Country:US
Practice Address - Phone:856-845-4061
Practice Address - Fax:856-384-1770
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06994600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH38080Medicare UPIN