Healthcare Provider Details

I. General information

NPI: 1912090812
Provider Name (Legal Business Name): RICHARD GABRIEL LOVANIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 MAIN ST SUITE 110
BRIDGEPORT CT
06606-5369
US

IV. Provider business mailing address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

V. Phone/Fax

Practice location:
  • Phone: 203-332-4744
  • Fax: 203-332-4751
Mailing address:
  • Phone: 203-576-6133
  • Fax: 203-581-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number013066
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: