Provider Demographics
NPI:1972545440
Name:LOUGH, FREDERICK CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CHARLES
Last Name:LOUGH
Suffix:JR
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 1:8901 WISCONSIN AVE
Mailing Address - Street 2:WRNMMC, CARDIOTHORACIC SURGERY
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0004
Mailing Address - Country:US
Mailing Address - Phone:301-319-2837
Mailing Address - Fax:301-295-2662
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:WRNMMC, CARDIOTHORACIC SURGERY
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0004
Practice Address - Country:US
Practice Address - Phone:301-319-2837
Practice Address - Fax:301-295-2662
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035580208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010228824Medicaid
MD404465702Medicaid
DC035556900Medicaid
MDCAREFIRST BC/BSOther64046002
DCJ4490007OtherCAREFIRST BC/BS
MDCAREFIRST BC/BSOther64046002
DCC34165Medicare UPIN