Healthcare Provider Details

I. General information

NPI: 1386809556
Provider Name (Legal Business Name): CHARITO LOVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2008
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S NUCLEAR MEDICINE SUITE
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S NUCLEAR MEDICINE SUITE
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-4897
  • Fax:
Mailing address:
  • Phone: 718-918-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number246221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: