Provider Demographics
NPI:1831149244
Name:LOOPER, JOHN STUART (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STUART
Last Name:LOOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:122 WARD ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1029
Mailing Address - Country:US
Mailing Address - Phone:617-855-3237
Mailing Address - Fax:617-855-3739
Practice Address - Street 1:122 WARD ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1029
Practice Address - Country:US
Practice Address - Phone:617-855-3237
Practice Address - Fax:617-855-3739
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA547102084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3035433Medicaid
MA3035433Medicaid
MAA59025Medicare UPIN