Provider Demographics
NPI:1215002043
Name:LORAH, JAY ARTHUR (DO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ARTHUR
Last Name:LORAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S RIVER RD
Mailing Address - Street 2:FAMILY PRACTICE
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6708
Mailing Address - Country:US
Mailing Address - Phone:603-695-2572
Mailing Address - Fax:
Practice Address - Street 1:25 S RIVER RD
Practice Address - Street 2:FAMILY PRACTICE
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6708
Practice Address - Country:US
Practice Address - Phone:603-695-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG66736Medicare UPIN