Provider Demographics
NPI:1952365249
Name:LOOSER, KEVIN GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GEORGE
Last Name:LOOSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:579 SAGAMORE AVE UNIT 38
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5569
Mailing Address - Country:US
Mailing Address - Phone:603-433-6994
Mailing Address - Fax:603-433-6995
Practice Address - Street 1:333 BORTHWICK AVE STE 305
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-6994
Practice Address - Fax:603-433-6995
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH5989208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP01156533OtherRAILROAD MEDICARE
NH3082884Medicaid
NHP01156533OtherRAILROAD MEDICARE
NHB85853Medicare UPIN
NHNH021801Medicare PIN