Provider Demographics
NPI:1649202441
Name:LORETZ, LORRAINE CHERYL (DPM, NP)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:CHERYL
Last Name:LORETZ
Suffix:
Gender:F
Credentials:DPM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 COLTON LN
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1818
Mailing Address - Country:US
Mailing Address - Phone:508-981-9471
Mailing Address - Fax:
Practice Address - Street 1:21 EASTERN AVE STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3094
Practice Address - Country:US
Practice Address - Phone:508-556-0223
Practice Address - Fax:774-420-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2313213E00000X
MA244610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073170AMedicaid
MA000359201Medicare PIN
MA110073170AMedicaid