Provider Demographics
NPI:1710914767
Name:LOFTUS, TAYLOE H (MD)
Entity Type:Individual
Prefix:
First Name:TAYLOE
Middle Name:H
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-3850
Mailing Address - Fax:315-464-3872
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-3850
Practice Address - Fax:315-464-3872
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY162291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01278293Medicaid
NY01278293Medicaid
NYP110061797Medicare PIN