Provider Demographics
NPI:1710213152
Name:CONNAUGHTON, LORETTA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:A
Last Name:CONNAUGHTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:609-890-1050
Mailing Address - Fax:609-890-0950
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 418
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002148363AM0700X
NJ25MP00307200363AM0700X
PAMA000501L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOA002148OtherLICENSE
PAMA000501LOtherSTATE LICENSE
NJ25MP00307200OtherSTATE LICENSE