Provider Demographics
NPI:1952792426
Name:LOVELACE, ROLAND THOMPSON JR (ATC)
Entity type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:THOMPSON
Last Name:LOVELACE
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N LOMBARDY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1711
Mailing Address - Country:US
Mailing Address - Phone:804-359-9408
Mailing Address - Fax:804-359-9408
Practice Address - Street 1:1500 N LOMBARDY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1711
Practice Address - Country:US
Practice Address - Phone:804-359-9408
Practice Address - Fax:804-359-9408
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126000867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist