Provider Demographics
NPI:1508886821
Name:LOESCH, HEATHER AIMEE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:AIMEE
Last Name:LOESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 DELANEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6002
Mailing Address - Country:US
Mailing Address - Phone:910-343-0626
Mailing Address - Fax:910-343-8012
Practice Address - Street 1:2504 DELANEY AVENUE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6002
Practice Address - Country:US
Practice Address - Phone:910-343-0626
Practice Address - Fax:910-343-8012
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000526207N00000X
GA048434207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC126ACOtherBCBS
NC562276621BOtherCIGNA
NC89126ACMedicaid
NC562276621BOtherCIGNA
H16137Medicare UPIN