Healthcare Provider Details

I. General information

NPI: 1871688838
Provider Name (Legal Business Name): EDITH LOVEGREN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 E 14TH AVE
DENVER CO
80220-2821
US

IV. Provider business mailing address

6311 E 14TH AVE
DENVER CO
80220-2821
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-6434
  • Fax: 303-333-6505
Mailing address:
  • Phone: 303-333-6434
  • Fax: 303-333-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number31930
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: