MEDICARE: SANDRA R LOVE M.D.

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	207R00000X	Internal Medicine Physician	16551	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00186717	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	576007863063	OTHER	SC	BCBS OF SC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5237092	OTHER	SC	AETNA
5	576007863063	OTHER	SC	BLUE CHOICE OF SC

General Provider Information

NPI Number	:	1518913896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA R LOVE M.D.

Provider Business Mailing Address
First Line	:	ONE INDEPENDENCE POINTE
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4566
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	877 W FARIS RD
Second Line	:	SUITE D
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4254
Country	:	US
Telephone Number	:	864-455-9050
Fax Number	:	864-455-9017

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	06/24/2011

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Directions to “ SANDRA R LOVE M.D.” Practice Location

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