1689677908 NPI number — DR. JOSE T LOVERIA MD

Table of content: DR. JOSE T LOVERIA MD (NPI 1689677908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689677908 NPI number — DR. JOSE T LOVERIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVERIA
Provider First Name:
JOSE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1689677908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1671
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21501-1671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-8515
Provider Business Mailing Address Fax Number:
240-964-8925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12502 WILLOWBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-6491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-8921
Provider Business Practice Location Address Fax Number:
240-964-8925
Provider Enumeration Date:
05/31/2005

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: 207R00000X , with the licence number:  D0050844 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 544222-01 . This is a "BCBS POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0401812 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 325901300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P12814 . This is a "BCBS POS PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0079534000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110144132 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 846868 . This is a "MDIPA/OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1040111861 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: W3990004 . This is a "BCBS FEDERAL" identifier . This identifiers is of the category "OTHER".




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