Provider Demographics
NPI:1598791907
Name:LOSCH, MARTHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:S
Last Name:LOSCH
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 1:795 WILLOW RD
Mailing Address - Street 2:MAIL CODE 170 A
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2539
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2710
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:MAIL CODE 170 A
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2710
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG759102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G759101OtherPALMETTO GBA
CA00G759100Medicaid
CA00G759100Medicaid
CA00G759101Medicare PIN
CAG21442Medicare ID - Type Unspecified