Provider Demographics
NPI:1619977253
Name:MCLOUGHLIN, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MCLOUGHLIN
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 1:803 PARK HILL CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1464
Mailing Address - Country:US
Mailing Address - Phone:937-279-9777
Mailing Address - Fax:937-279-9332
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:SUITE 301
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1830
Practice Address - Country:US
Practice Address - Phone:937-279-9777
Practice Address - Fax:937-279-9332
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084126208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2484431Medicaid
OHMC4132391Medicare ID - Type Unspecified
OHF90258Medicare UPIN