Provider Demographics
NPI:1700123908
Name:LOVING CARE MEDICAL PC
Entity Type:Organization
Organization Name:LOVING CARE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-704-0953
Mailing Address - Street 1:13203 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2916
Mailing Address - Country:US
Mailing Address - Phone:718-704-0953
Mailing Address - Fax:718-228-2601
Practice Address - Street 1:13203 120TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2916
Practice Address - Country:US
Practice Address - Phone:718-704-0953
Practice Address - Fax:718-228-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03582189Medicaid
G100084691OtherMEDICARE GROUP NUMBER