Healthcare Provider Details

I. General information

NPI: 1932152717
Provider Name (Legal Business Name): PETER CHARLES ALBERT LOVETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY BERKELEY PRIMARY CARE, ROOM 1363
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY BERKELEY PRIMARY CARE, ROOM 1363
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: