Provider Demographics
NPI:1215205380
Name:LOIURIO, JESSE O (PA-C)
Entity Type:Individual
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First Name:JESSE
Middle Name:O
Last Name:LOIURIO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:725 ALBANY ST
Practice Address - Street 2:SHAPIRO 7, SUITE C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8992
Practice Address - Fax:617-638-8979
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2015-11-09
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Provider Licenses
StateLicense IDTaxonomies
MAPA4276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant