Provider Demographics
NPI:1629268149
Name:LOVORN, MEGAN B (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:LOVORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 N CHURCH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1035
Mailing Address - Country:US
Mailing Address - Phone:336-663-4900
Mailing Address - Fax:336-663-4920
Practice Address - Street 1:1126 N CHURCH ST STE 103
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1035
Practice Address - Country:US
Practice Address - Phone:336-663-4900
Practice Address - Fax:336-663-4920
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01308208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
201087OtherMEDCOST
9510114OtherAETNA
VA1629268149Medicaid
WV3810011222Medicaid
147CKOtherBCBS
NC5908245Medicaid
810625OtherPARTNERS
SCQ0130DMedicaid
SCQ0130DMedicaid