Provider Demographics
NPI:1871609081
Name:LORADITCH, JOHN CHARLES (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:LORADITCH
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 1:116 DANBURY RD
Mailing Address - Street 2:UNIT 3201
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4461
Mailing Address - Country:US
Mailing Address - Phone:203-602-7778
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223758207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services