Provider Demographics
NPI:1952462426
Name:LOFTUS, ANDREW WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNI
Mailing Address - Street 2:KAISER PERMANENTE 6 WEST ATTN THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:8261 WILLOW OAKS CORPORATE DR
Practice Address - Street 2:KPIC
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:703-205-3600
Practice Address - Fax:703-205-3650
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD057925L2085R0202X
DCMD330742085R0202X
VA01012331652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43387Medicare UPIN
011870M92Medicare ID - Type Unspecified