Provider Demographics
NPI:1336142447
Name:LOEB, THOMAS MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARION
Last Name:LOEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-253-4120
Mailing Address - Fax:502-253-4121
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:SUITE 310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-253-4120
Practice Address - Fax:502-253-4121
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16798207X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1299470001OtherPTAN
KY6590150Medicaid
KY1299470001OtherPTAN
KY0620401Medicare PIN
KY6590150Medicaid