Provider Demographics
NPI:1760473870
Name:LOVEGROVE, GEORGE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:LOVEGROVE
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 1:4130 ROBERT C BYRD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2206
Mailing Address - Country:US
Mailing Address - Phone:304-252-3900
Mailing Address - Fax:304-252-9311
Practice Address - Street 1:4130 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2206
Practice Address - Country:US
Practice Address - Phone:304-252-3900
Practice Address - Fax:304-252-9311
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0082892000Medicaid
WVA72297Medicare UPIN
WV0082892000Medicaid