Provider Demographics
NPI:1881691343
Name:LOVE, THOMAS ROBERT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:LOVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-7942
Mailing Address - Fax:740-356-7851
Practice Address - Street 1:1000 ASHLAND DR STE 103
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7092
Practice Address - Country:US
Practice Address - Phone:606-324-0098
Practice Address - Fax:606-324-0315
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25675207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64256753Medicaid
KY90040452OtherMEDICAID SUPPLIER NUMBER
OH0257707Medicaid
KY90040452OtherMEDICAID SUPPLIER NUMBER
KYC76390Medicare UPIN