Provider Demographics
NPI:1477648582
Name:O'LOUGHLIN, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:O'LOUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 ERDMAN WAY
Mailing Address - Street 2:SUITE 315.
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-537-4805
Mailing Address - Fax:978-537-2185
Practice Address - Street 1:80 ERDMAN WAY
Practice Address - Street 2:SUITE 315.
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-537-4805
Practice Address - Fax:978-537-2185
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA28368207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6167373Medicaid
MAM07476Medicare ID - Type Unspecified
MAA65902Medicare UPIN