Provider Demographics
NPI:1962460329
Name:LOFTUS, RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 836
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5795
Practice Address - Country:US
Practice Address - Phone:716-630-1112
Practice Address - Fax:716-631-0584
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19483312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
161538169OtherEMPIRE
RB6953OtherMEDICARE
040426003023OtherFIDELIS
NY1948330DNUMOtherWORKERS COMPENSATION
300112060OtherRAILROAD MEDICARE
P00129852OtherMEDICARE RAILROAD
P00003635OtherRAILROAD MEDICARE
00026963902OtherUNIVERA
000525341011OtherBLUE SHIELD OF WESTERN NY
204329201OtherEMPIRE
000525341007OtherBLUE SHIELD OF WESTERN NY
5690141OtherINDEPENDENT HEALTH
145796FFOtherPREFERRED CARE
000525341013OtherBLUE SHIELD OF WESTERN NY
000525341014OtherBLUE SHIELD OF WESTERN NY
NY01871172Medicaid
743079229OtherEMPIRE
P00003635OtherRAILROAD MEDICARE
300112060OtherRAILROAD MEDICARE
145796FFOtherPREFERRED CARE
DD4904Medicare ID - Type Unspecified