MEDICARE: THOMAS JOHN LOVELY 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	208600000X	Surgery Physician	184886	NY
2	207T00000X	Neurological Surgery Physician	184886	NY

General Provider Information

NPI Number	:	1114982105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOHN LOVELY MD

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1182 TROY SCHENECTADY RD SUITE 100
Second Line	:	ST. PETER'S HOSPITAL SPINE AND NEUROSURGERY
City	:	LATHAM
State	:	NY
Zip	:	12110-1000
Country	:	US
Telephone Number	:	518-713-5400
Fax Number	:	518-713-5401

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	04/06/2022

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