Provider Demographics
NPI:1437348810
Name:LOVELAND FAMILY MEDICINE, LTD
Entity Type:Organization
Organization Name:LOVELAND FAMILY MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHBOOB
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-683-3020
Mailing Address - Street 1:411 W LOVELAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2357
Mailing Address - Country:US
Mailing Address - Phone:513-683-3020
Mailing Address - Fax:513-677-4585
Practice Address - Street 1:411 W LOVELAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2357
Practice Address - Country:US
Practice Address - Phone:513-683-3020
Practice Address - Fax:513-677-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9319121Medicare PIN