Provider Demographics
NPI:1487435632
Name:LOSH, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4025
Mailing Address - Country:US
Mailing Address - Phone:440-821-2332
Mailing Address - Fax:
Practice Address - Street 1:1977 HATHAWAY DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4025
Practice Address - Country:US
Practice Address - Phone:440-821-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRM803705172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver