Provider Demographics
NPI:1245467836
Name:LOVE, THORVARDUR JON (MD)
Entity type:Individual
Prefix:
First Name:THORVARDUR
Middle Name:JON
Last Name:LOVE
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 1:1723 WASHINGTON ST
Mailing Address - Street 2:APT 301
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1820
Mailing Address - Country:US
Mailing Address - Phone:617-820-5226
Mailing Address - Fax:617-812-2429
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:PBB-B3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222625390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program