Basic Information
| Provider Information | |||||||||
| NPI: | 1194784462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOVETT | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023023308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089417000 | ||||||||
| FaxNumber: | 5085650012 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027671942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088940400 | ||||||||
| FaxNumber: | 5085650012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 0488 | MP | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 15132 | NH | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | M-1660 | GU | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 127922 | CO | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 0102864A | IN | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 22967 | AZ | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 256442 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 110088645A | 05 | MA | MEDICAID | 30209941 | 05 | NH | MEDICAID |