MEDICARE: WALTER KENNETH LOVE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	012987	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	100367	OTHER	ME	ANTHEM
3	1396848297	OTHER	ME	GROUP NPI #
4	043833726	OTHER	ME	TAX ID #

General Provider Information

NPI Number	:	1104827120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER KENNETH LOVE MD

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572
Country	:	US
Telephone Number	:	207-832-5813
Fax Number	:	207-832-3070

Provider Business Practice Location Address
First Line	:	1034 MAIN ST
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-6037
Country	:	US
Telephone Number	:	207-832-5813
Fax Number	:	207-832-3070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/01/2017

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Directions to “ WALTER KENNETH LOVE MD” Practice Location

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