Provider Demographics
NPI:1962607226
Name:LOVERIDGE, BENJAMIN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RICHARD
Last Name:LOVERIDGE
Suffix:
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 1:3900 S MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1307
Mailing Address - Country:US
Mailing Address - Phone:765-388-2671
Mailing Address - Fax:
Practice Address - Street 1:3900 S MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1307
Practice Address - Country:US
Practice Address - Phone:765-388-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066134A208D00000X
CO47923208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice