Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 15311 | NH |
N | 111NI0900X | Internist | 15311 | NH |
Y | 207R00000X | Internist | 50685 | MN |
Y | 111NI0900X | Internist | 50685 | MN |
N | 207R00000X | Internist | LP00188 | RI |
N | 111NI0900X | Internist | LP00188 | RI |
NPI | 1003032574 |
---|---|
Provider Name | Elias Loukas |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 12/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35366000 | (05) | WI |
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
P00617248 | RAILROAD MEDICARE (01) | MN |