Provider Demographics
NPI:1194784462
Name:LOVETT, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:LOVETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7000
Mailing Address - Fax:508-565-0012
Practice Address - Street 1:1215 BROADWAY
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1942
Practice Address - Country:US
Practice Address - Phone:508-894-0400
Practice Address - Fax:508-565-0012
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0488207N00000X
NH15132207N00000X
GUM-1660207N00000X
CO127922207N00000X
IN0102864A207N00000X
AZ22967207N00000X
MA256442207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088645AMedicaid
NH30209941Medicaid
MA110088645AMedicaid
AZ69301Medicare PIN
F92221Medicare UPIN
NH001897401Medicare PIN