Provider Demographics
NPI:1275641029
Name:LOIODICE, JOHN ANTHONY (MD, FACS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:LOIODICE
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Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4111
Mailing Address - Country:US
Mailing Address - Phone:413-448-8291
Mailing Address - Fax:413-447-9040
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4111
Practice Address - Country:US
Practice Address - Phone:413-448-8291
Practice Address - Fax:413-447-9040
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA45563207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0109169Medicaid
MAI22266Medicare ID - Type Unspecified
MA0109169Medicaid