Provider Demographics
NPI:1447828058
Name:LOFFREDO, SAMUEL MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MICHAEL
Last Name:LOFFREDO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-629-2282
Mailing Address - Fax:570-476-3475
Practice Address - Street 1:447 PLAZA COURT
Practice Address - Street 2:BUILDING 500
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1830
Practice Address - Country:US
Practice Address - Phone:570-426-2301
Practice Address - Fax:570-476-2306
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA062499363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA062499OtherLICENSE