Provider Demographics
NPI:1023102548
Name:LOUGH, IRENE ALEXANDRA (FNP)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:ALEXANDRA
Last Name:LOUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 INNSBRUCK RD.
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3057
Mailing Address - Country:US
Mailing Address - Phone:315-656-9412
Mailing Address - Fax:
Practice Address - Street 1:750 E. ADAMS ST.
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279396Medicaid
NYML0108212OtherDEA #
NYP01921Medicare UPIN