Provider Demographics
NPI:1538180799
Name:O'LOUGHLIN, GERARD J (DO)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:O'LOUGHLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-473-2000
Mailing Address - Fax:304-473-2180
Practice Address - Street 1:1 AMALIA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2239
Practice Address - Country:US
Practice Address - Phone:304-473-2000
Practice Address - Fax:304-473-2180
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV1215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0052965000Medicaid
WVOL7361371Medicare PIN
WVE88388Medicare UPIN