Healthcare Provider Details

I. General information

NPI: 1205056199
Provider Name (Legal Business Name): LORI EVE LOVITZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ERIE AVE
PHILADELPHIA PA
19134-1011
US

IV. Provider business mailing address

2650 RIDGE AVE DEPARTMENT OF NEUROLOGY
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5470
  • Fax:
Mailing address:
  • Phone: 847-663-8200
  • Fax: 847-570-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberOS023327
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberOS023327
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS023327
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOT010884
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036120523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: