Individual
DR. MARIO G LOOMIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 DOLSON AVE, SUITE 302, MIDDLETOWN, NY 10940-6569
(845) 342-6884
(845) 342-4989
Mailing address
225 DOLSON AVE, SUITE 302, MIDDLETOWN, NY 10940-6569
(845) 342-6884
(845) 342-4989
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
198000
NY
208200000X
Plastic Surgery Physician
69053
NJ
208200000X
Plastic Surgery Physician
MD046328L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01553864
—
NY
Enumeration date
10/03/2006
Last updated
07/08/2007
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