Provider Demographics
NPI:1275624702
Name:LOVE, JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LOVE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4020
Mailing Address - Country:US
Mailing Address - Phone:207-368-4213
Mailing Address - Fax:207-355-3033
Practice Address - Street 1:118 MOOSEHEAD TRL
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4020
Practice Address - Country:US
Practice Address - Phone:207-368-4213
Practice Address - Fax:207-355-3033
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP0633Medicare ID - Type Unspecified
MEP30406Medicare UPIN