Provider Demographics
NPI:1104923010
Name:LOVELL, KENNETH FRANK (D O)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:FRANK
Last Name:LOVELL
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 W MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-9110
Mailing Address - Country:US
Mailing Address - Phone:717-656-2424
Mailing Address - Fax:717-665-5142
Practice Address - Street 1:1065 W MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-9110
Practice Address - Country:US
Practice Address - Phone:717-656-2424
Practice Address - Fax:717-665-5142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003492L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE06274Medicare UPIN