Provider Demographics
NPI:1427086966
Name:LOUGHLIN, CHRISTOPHER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:LOUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-574-5997
Mailing Address - Fax:203-574-5987
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-574-5997
Practice Address - Fax:203-574-5987
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057665207Y00000X
NC9300745207Y00000X
RIMD12292207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010255201Medicaid
VA00X006M03Medicare ID - Type Unspecified
VA010255201Medicaid