Provider Demographics
NPI:1881650703
Name:LOUGHLIN-PHERRIBO, DONNA JOYCE (DO)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JOYCE
Last Name:LOUGHLIN-PHERRIBO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1804
Mailing Address - Country:US
Mailing Address - Phone:609-561-4211
Mailing Address - Fax:609-561-1536
Practice Address - Street 1:120 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1804
Practice Address - Country:US
Practice Address - Phone:609-561-4211
Practice Address - Fax:609-561-1536
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07418200207Q00000X
PAOS008092L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0150762Medicaid
NJ120437SBVMedicare PIN
G21375Medicare UPIN