Provider Demographics
NPI:1417948852
Name:LOFTUS, MATTHEW SEAN (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SEAN
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:GLENS FALLS HOSPITAL HOSPITALIST PROGRAM
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5925
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY007722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02347946Medicaid
NYP00007685OtherRR MEDICARE
NY02347946Medicaid
NYP00007685OtherRR MEDICARE