Provider Demographics
NPI:1346248648
Name:LOY, FREDERICK P (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:P
Last Name:LOY
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 1:140 HOSPITAL DR
Mailing Address - Street 2:MEDICAL BUILDING
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5009
Mailing Address - Country:US
Mailing Address - Phone:802-447-0607
Mailing Address - Fax:802-447-0608
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:MEDICAL BUILDING
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-447-0607
Practice Address - Fax:802-447-0608
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0005776208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004673Medicaid
VT0004673Medicaid
VTVT4673Medicare ID - Type Unspecified