Provider Demographics
NPI:1396733150
Name:LOVELAND, MARY W (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:W
Last Name:LOVELAND
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 1:5735 RIDGE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1747
Mailing Address - Country:US
Mailing Address - Phone:215-483-9054
Mailing Address - Fax:215-483-6533
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1747
Practice Address - Country:US
Practice Address - Phone:215-483-9054
Practice Address - Fax:215-483-6533
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028790L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004207573OtherAETNA
018919OtherHIGHMARK BS
2Y5444OtherELDER HEALTH
J18919OtherAH
6209688OtherCIGNA
0052735000OtherIBC
J18919OtherAH
018919Medicare ID - Type Unspecified