Provider Demographics
NPI:1053357046
Name:VERDE, LORETO (PA)
Entity type:Individual
Prefix:MRS
First Name:LORETO
Middle Name:
Last Name:VERDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LORETO
Other - Middle Name:
Other - Last Name:COMPERATORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 WASHINGTON ST
Mailing Address - Street 2:STE 540
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-912-5721
Mailing Address - Fax:
Practice Address - Street 1:11 ARTHUR DR
Practice Address - Street 2:APT 1 J
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1234
Practice Address - Country:US
Practice Address - Phone:860-912-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000777363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000305Medicare ID - Type Unspecified
CTR89042Medicare UPIN