Provider Demographics
NPI:1043222029
Name:LOVENTHAL, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:LOVENTHAL
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:45 MOONBOW PLZ
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8949
Practice Address - Country:US
Practice Address - Phone:606-523-9010
Practice Address - Fax:606-528-0028
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20074207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64200744Medicaid
KYP01427513OtherRR MEDICARE
KYP01427513OtherRR MEDICARE
KY0527610Medicare ID - Type Unspecified
KYC64772Medicare UPIN
KY0573210Medicare ID - Type Unspecified
KY0573110Medicare ID - Type Unspecified
KY0789616Medicare ID - Type Unspecified
KY0573710Medicare ID - Type Unspecified
KY64200744Medicaid