Provider Demographics
NPI:1932178894
Name:OPILA, LORETTA A (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:A
Last Name:OPILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 LOCUST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1651
Mailing Address - Country:US
Mailing Address - Phone:814-534-6242
Mailing Address - Fax:814-534-6731
Practice Address - Street 1:315 LOCUST ST STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1651
Practice Address - Country:US
Practice Address - Phone:814-534-6242
Practice Address - Fax:814-534-6731
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039378L207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000958645Medicaid
PA0009586450004Medicaid