Provider Demographics
NPI:1114982105
Name:LOVELY, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:LOVELY
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 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1182 TROY SCHENECTADY RD SUITE 100
Practice Address - Street 2:ST. PETER'S HOSPITAL SPINE AND NEUROSURGERY
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-713-5400
Practice Address - Fax:518-713-5401
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184886208600000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA1691Medicare ID - Type Unspecified
E89440Medicare UPIN