Provider Demographics
NPI:1518986348
Name:LOVALLO, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:LOVALLO
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 1:2445 ARMY NAVY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2905
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-799-5989
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-799-5989
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048993207XS0114X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
148820100OtherDEPT OF LABOR ID
4304627OtherAETNA PPO
0005OtherCIGNA ID
0738321OtherAETNA HMO
00196OtherUNITED ID
25090039OtherBLUE CROSS BLUE SHIELD ID
502350OtherNCPPO
074829OtherANTHEM ID
0738321OtherAETNA HMO
25090039OtherBLUE CROSS BLUE SHIELD ID
VAB74650Medicare UPIN