Healthcare Provider Details

I. General information

NPI: 1831356948
Provider Name (Legal Business Name): CHARLES F. LOVELL, JR., M.D., FACP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2008
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 TIDEWATER DR STE 1
NORFOLK VA
23504-2840
US

IV. Provider business mailing address

1401 TIDEWATER DR STE 1
NORFOLK VA
23504-2840
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-3038
  • Fax: 757-623-0101
Mailing address:
  • Phone: 757-623-3038
  • Fax: 757-623-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27439
License Number StateVA

VIII. Authorized Official

Name: DR. CHARLES F. LOVELL JR.
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 757-623-3038