Provider Demographics
NPI:1932289899
Name:LOUGHLIN, BRUCE TIMOTHY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TIMOTHY
Last Name:LOUGHLIN
Suffix:
Gender:M
Credentials:DO
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 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1055 HAMBURG TPKE
Practice Address - Street 2:SUITE 300
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3235
Practice Address - Country:US
Practice Address - Phone:973-904-1177
Practice Address - Fax:973-904-1166
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04283000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LO454892Medicare ID - Type Unspecified
C53678Medicare UPIN