Provider Demographics
NPI:1952538696
Name:MATTHEW W. LOUGHLIN, M.D., L.L.C.
Entity Type:Organization
Organization Name:MATTHEW W. LOUGHLIN, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-329-2224
Mailing Address - Street 1:1302 LAKEWOOD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1800
Mailing Address - Country:US
Mailing Address - Phone:337-329-2224
Mailing Address - Fax:337-329-2230
Practice Address - Street 1:1302 LAKEWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1800
Practice Address - Country:US
Practice Address - Phone:337-329-2224
Practice Address - Fax:337-329-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-21
Last Update Date:2010-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA18/18763Medicaid
LA18/18763Medicaid