1396733150 NPI number — MARY W LOVELAND MD

Table of content: MARY W LOVELAND MD (NPI 1396733150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396733150 NPI number — MARY W LOVELAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVELAND
Provider First Name:
MARY
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396733150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5735 RIDGE AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19128-1747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-483-9054
Provider Business Mailing Address Fax Number:
215-483-6533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5735 RIDGE AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-9054
Provider Business Practice Location Address Fax Number:
215-483-6533
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  MD028790L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004207573 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 018919 . This is a "HIGHMARK BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2Y5444 . This is a "ELDER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J18919 . This is a "AH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6209688 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0052735000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".




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