Provider Demographics
NPI:1891800132
Name:LOOS, DANIELLE M (PA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:LOOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:40 HART ST
Mailing Address - Street 2:BUILDING C
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1743
Mailing Address - Country:US
Mailing Address - Phone:860-229-8889
Mailing Address - Fax:860-229-8893
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:BUILDING C
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1743
Practice Address - Country:US
Practice Address - Phone:860-229-8889
Practice Address - Fax:860-229-8893
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001122363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherCORVEL
CT290001122CT02OtherANTHEM BCBS
CT06-1406459OtherTRICARE
CT020225OtherCONNECTICARE
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
CT06-1406459OtherPIONEER
CT06-1406459OtherGREAT-WEST HEALTHCARE
CT06-1406459OtherMULTIPLAN
CT3V2219OtherHEALTH NET
CT970002732Medicare PIN
CT3V2219OtherHEALTH NET
CT290001122CT02OtherANTHEM BCBS