Provider Demographics
NPI:1063445906
Name:LOVDAL, JAMIE A (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:LOVDAL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:5-4257 BASTOGNE STREET
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-7233
Practice Address - Country:US
Practice Address - Phone:910-907-6290
Practice Address - Fax:910-907-9606
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-11-06
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Provider Licenses
StateLicense IDTaxonomies
NC9901572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H45944Medicare UPIN