Provider Demographics
NPI:1558470740
Name:LONEY, DAVID J (CP, BOC(O))
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LONEY
Suffix:
Gender:M
Credentials:CP, BOC(O)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HANOVER ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1020
Mailing Address - Country:US
Mailing Address - Phone:603-381-6561
Mailing Address - Fax:603-443-9972
Practice Address - Street 1:190 HANOVER ST STE 3A
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1020
Practice Address - Country:US
Practice Address - Phone:603-252-6561
Practice Address - Fax:603-443-9972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076932Medicaid
VT1005350Medicaid
VT1005350Medicaid