Provider Demographics
NPI:1386625259
Name:LOVETT, ETHRIDGE JUNE JR (MD)
Entity type:Individual
Prefix:DR
First Name:ETHRIDGE
Middle Name:JUNE
Last Name:LOVETT
Suffix:JR
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 1:8427 MASTERS CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-2226
Mailing Address - Country:US
Mailing Address - Phone:202-782-9513
Mailing Address - Fax:202-782-5452
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-785-9513
Practice Address - Fax:202-782-5452
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045140171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider