Provider Demographics
NPI:1093469819
Name:LOVELACE, JOSH R
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:R
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 10TH ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-6607
Mailing Address - Country:US
Mailing Address - Phone:302-571-9622
Mailing Address - Fax:
Practice Address - Street 1:100 W 10TH ST STE 1100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-6607
Practice Address - Country:US
Practice Address - Phone:302-571-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator