Provider Demographics
NPI:1124297924
Name:LOVELACE, PEGGY ANN (RD,LDN,CDE)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:RD,LDN,CDE
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:BUDKE
Other - Last Name:LOVELACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CDE
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2790
Mailing Address - Fax:717-798-3162
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:STE 205
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-339-2790
Practice Address - Fax:717-798-3162
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000831133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063460Medicare PIN