Provider Demographics
NPI:1396941225
Name:GEORGE E. LOVEGROVE, M.D.
Entity type:Organization
Organization Name:GEORGE E. LOVEGROVE, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOVEGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-252-3900
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 1:4522 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1840
Practice Address - Country:US
Practice Address - Phone:304-926-1001
Practice Address - Fax:304-926-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002434Medicaid
WV3810002434Medicaid