Provider Demographics
NPI:1144719584
Name:LOVELACE, ALLEN
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1550
Mailing Address - Country:US
Mailing Address - Phone:614-623-5510
Mailing Address - Fax:
Practice Address - Street 1:2246 S HAMILTON RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4317
Practice Address - Country:US
Practice Address - Phone:855-519-2787
Practice Address - Fax:614-868-1690
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No175T00000XOther Service ProvidersPeer Specialist