Provider Demographics
NPI:1487781076
Name:LOVIG, LINDA H (NP, CNM)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:H
Last Name:LOVIG
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E GENESEE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3108
Mailing Address - Country:US
Mailing Address - Phone:315-426-1100
Mailing Address - Fax:315-426-1153
Practice Address - Street 1:600 E GENESEE ST STE 104
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3108
Practice Address - Country:US
Practice Address - Phone:315-426-1100
Practice Address - Fax:315-426-1153
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY408574164W00000X
NYF000574176B00000X
NYF360250363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02502472Medicaid
NY760768597OtherAETNA
NY760768597OtherONEIDA NATION
NY01487012Medicaid
NY100174455401OtherUNITED HEALTHCARE
NY760768597OtherBEECH STREET
NY760768597OtherCIGNA
NMCAQHOther11378735
NY384476OtherMVP
NY760768597OtherUNICARE
NY000004218OtherEXCELLUS BC BS CENTRAL NY
NY000004218OtherRMSCO
NY00040025002OtherUNIVERA
NY050211000003OtherFIDELIS CARE NY
NY760768597OtherBEECH STREET
NYBA0466Medicare ID - Type UnspecifiedGROUP
NY02502472Medicaid