Provider Demographics
NPI:1962449066
Name:LOOSER, JORDY (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDY
Middle Name:
Last Name:LOOSER
Suffix:
Gender:M
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 1:333 BORTHWICK AVENUE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-559-4111
Mailing Address - Fax:
Practice Address - Street 1:333 BORTHWICK AVENUE
Practice Address - Street 2:SUITE 402
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-559-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-568363AM0700X
NH0282P363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077059Medicaid
NHP01425995OtherRAILROAD MEDICARE
TNAP264601Medicare PIN
NHT400178118Medicare PIN
NHP01425995OtherRAILROAD MEDICARE
NH30010928Medicaid
NHS47077Medicare UPIN
NHP00359674Medicare PIN