Provider Demographics
NPI:1487624888
Name:LOESCHER, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LOESCHER
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:PO BOX 6260
Mailing Address - Street 2:230 MAPLE ST
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-6260
Mailing Address - Country:US
Mailing Address - Phone:413-420-2200
Mailing Address - Fax:413-420-2260
Practice Address - Street 1:230 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5124
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:413-420-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7935OtherBOSTON HEALTH NET
MA0001929OtherNEIGHBORHOOD HEALTH PLAN
MA974563OtherNETWORK HEALTH
MALOG01022OtherBLUE CROSS BLUE SHIELD
MAA22159Medicare ID - Type UnspecifiedMEDCARE NUMBER
MAA55190Medicare UPIN