Provider Demographics
NPI:1629003645
Name:LOVE, DENNIS PAUL (PA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PAUL
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 1:112 HILLVUE DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3426
Mailing Address - Country:US
Mailing Address - Phone:724-287-0791
Mailing Address - Fax:724-287-2730
Practice Address - Street 1:112 HILLVUE DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-3426
Practice Address - Country:US
Practice Address - Phone:724-287-0791
Practice Address - Fax:724-287-2730
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000110L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA970007590Medicaid
PA970007590Medicaid
R59224Medicare UPIN
PA557400Medicare ID - Type Unspecified