Provider Demographics
NPI:1285739250
Name:LOVE, KAREN ROYAL (MD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ROYAL
Last Name:LOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 W BROAD ST
Mailing Address - Street 2:SUITE R
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6709
Mailing Address - Country:US
Mailing Address - Phone:804-934-0060
Mailing Address - Fax:804-934-0024
Practice Address - Street 1:10120 W EST BROAD STREET
Practice Address - Street 2:SUITE R
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6709
Practice Address - Country:US
Practice Address - Phone:804-934-0060
Practice Address - Fax:804-934-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051656173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADD7147OtherMEDICARE /RAILROAD
VA183408OtherANTHEM
VA183408OtherANTHEM