Provider Demographics
NPI:1770583320
Name:PRATT, LORETTA A (MD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:A
Last Name:PRATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1850 E PARK AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-237-6600
Mailing Address - Fax:814-237-5383
Practice Address - Street 1:1850 E PARK AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-237-6600
Practice Address - Fax:814-237-5383
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD21694207N00000X
NY1577481207N00000X
PAMD038745E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE15022Medicare UPIN
PAE15022Medicare UPIN