Provider Demographics
NPI:1922040567
Name:LOVELESS, MEREDITH (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:LOVELESS
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:PO BOX 766351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST STE 600
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3902
Practice Address - Country:US
Practice Address - Phone:502-629-3730
Practice Address - Fax:502-629-3734
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61836207V00000X
KY42624207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3743356000OtherPASSPORT ADVANTAGE # - PSC
KY50026138OtherPASSPORT - PSC SPECIALIST
KY7100088370Medicaid
IN200958150Medicaid
KY50026137OtherPASSPORT - PCP -FOUNDATION
KY50026136OtherPASSPORT SPECIALTY -FOUNDATION
KY50026136OtherPASSPORT SPECIALTY -FOUNDATION
IN200958150Medicaid
KY0979733Medicare PIN