Provider Demographics
NPI:1134222672
Name:LOVELLE-ALLEN, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:LOVELLE-ALLEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 BIRDHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8212
Mailing Address - Country:US
Mailing Address - Phone:919-925-5910
Mailing Address - Fax:919-704-7535
Practice Address - Street 1:7718 SIX FORKS RD STE 106
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5072
Practice Address - Country:US
Practice Address - Phone:919-925-5910
Practice Address - Fax:919-704-7535
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201488202D00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111178020OtherPTAN
KS200585240CMedicaid
KS200585240CMedicaid