Healthcare Provider Details

I. General information

NPI: 1083812929
Provider Name (Legal Business Name): SHANE B. LOVLEY P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 RIVER ROAD
NEWCASTLE ME
04553-3838
US

IV. Provider business mailing address

80 RIVER ROAD
NEWCASTLE ME
04553-3838
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-3366
  • Fax: 207-563-3393
Mailing address:
  • Phone: 207-563-3366
  • Fax: 207-563-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA001090
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: