Provider Demographics
NPI:1083978019
Name:LOVASCO, SIMON A (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:A
Last Name:LOVASCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIMON-ALEXANDRE
Other - Middle Name:
Other - Last Name:LOVASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-491-2855
Mailing Address - Fax:859-655-4395
Practice Address - Street 1:5100 PEACE WAY
Practice Address - Street 2:
Practice Address - City:TAYLOR MILL
Practice Address - State:KY
Practice Address - Zip Code:41015-3506
Practice Address - Country:US
Practice Address - Phone:859-491-2855
Practice Address - Fax:859-655-4395
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100307620Medicaid
KYK147170Medicare PIN