Provider Demographics
NPI:1184868069
Name:LOOMIS, CAITLIN (MD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:LOOMIS
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 1:15 YORK ST
Mailing Address - Street 2:LCI 912
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520
Mailing Address - Country:US
Mailing Address - Phone:203-737-1057
Mailing Address - Fax:203-737-4382
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:LCI 912
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-737-1057
Practice Address - Fax:203-737-4382
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT528192084N0400X, 2084V0102X, 2084N0400X
PAMT194634390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program