Provider Demographics
NPI:1619921723
Name:LOFGREN, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LOFGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 APRIL DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7939
Mailing Address - Country:US
Mailing Address - Phone:330-212-0790
Mailing Address - Fax:
Practice Address - Street 1:20 S 3RD ST STE 210TH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4206
Practice Address - Country:US
Practice Address - Phone:629-201-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083681I207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000356180OtherANTHEM
OH341779226006OtherMED MUTUAL OF OH
OHP00222417OtherRR MEDICARE
OH341779226SLOtherSUMMACARE
OH61641OtherUNITED HEALTHCARE
OH2475174Medicaid
OH4139863Medicare ID - Type Unspecified