Glen R Lovejoy, MD
Individual provider Active NPI Emergency Medicine Physician · Middlebury, VT
NPI 1154413615 · NPPES record last updated Jan 29, 2011
Key facts
- NPI
- 1154413615
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 420007650 (VT)
- Practice address
- 115 Porter Drive
Porter Hospital
Middlebury, VT 05753 - Phone
- (802) 388-4001
- Fax
- (802) 388-5612
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140418000081 | MA | Practitioner - Undersea and Hyperbaric Medicine |
5193705556 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 420007650 | VT | MD | Emergency Medicine Physician |
| 003305 | CT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Hospital | Current |
Accepting new patients | |
| Fairview Hospital | Current |
Accepting new patients | |
| Fairview Hospital | Current |
Accepting new patients | |
| Porter Hospital Inc | Past | Accepting new patients |
Locations
10 Maple Ave
Great Barrington, MA 01230
Phone (413) 854-9910
29 Lewis Ave
Gt Barrington, MA 01230
Phone (413) 528-0790
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 420007650 | VT | Yes |
Addresses
Primary practice location
115 Porter Drive
Porter Hospital
Middlebury, VT 05753
Mailing address
30 Cobb City Rd
Colebrook, CT 06021-1121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009688 | Medicaid | VT | |
| 3843 | Medicaid | NY | |
| 77V126 | Other | VT | MVP |
| 3843 | Other | VT | BCBS |
Other providers in Middlebury, VT
- Kathleen Lombard
- Hannah Elizabeth Lones
- Long Trail Psychiatry, LLC
- Kristine S Lorentzsen
- Sarah Irene Louer
- Faith Lee Lowell
- Lianne Lussier
- Courtney Mackey
- Judd C Mackey
- Emily M Mahar Cannon
All providers in Middlebury, VT · Emergency Medicine Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.