Provider Demographics
NPI:1346505732
Name:LOVING, JEREMY (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:LOVING
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:STAR LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:13690-3143
Mailing Address - Country:US
Mailing Address - Phone:315-848-3351
Mailing Address - Fax:315-848-3285
Practice Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Practice Address - Street 2:
Practice Address - City:STAR LAKE
Practice Address - State:NY
Practice Address - Zip Code:13690-3143
Practice Address - Country:US
Practice Address - Phone:315-848-3351
Practice Address - Fax:315-848-3285
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004477363AM0700X
NY020254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical