Provider Demographics
NPI:1831356948
Name:CHARLES F. LOVELL, JR., M.D., FACP, P.C.
Entity type:Organization
Organization Name:CHARLES F. LOVELL, JR., M.D., FACP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-623-3038
Mailing Address - Street 1:1401 TIDEWATER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2840
Mailing Address - Country:US
Mailing Address - Phone:757-623-3038
Mailing Address - Fax:757-623-0101
Practice Address - Street 1:1401 TIDEWATER DR STE 1
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2840
Practice Address - Country:US
Practice Address - Phone:757-623-3038
Practice Address - Fax:757-623-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA27439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006074936Medicaid
VAB06010Medicare UPIN
VA006074936Medicaid