Provider Demographics
NPI:1619931243
Name:LOVELY, WELDON R (DPM)
Entity Type:Individual
Prefix:DR
First Name:WELDON
Middle Name:R
Last Name:LOVELY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1454 SCALP AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3321
Mailing Address - Country:US
Mailing Address - Phone:814-266-6164
Mailing Address - Fax:814-269-2306
Practice Address - Street 1:1454 SCALP AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3321
Practice Address - Country:US
Practice Address - Phone:814-266-6164
Practice Address - Fax:814-269-2306
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003125L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30227Medicare UPIN