Individual
DR. EBONY LASHAY LOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
148 N 8TH ST, PHILADELPHIA, PA 19107-2418
(215) 777-5808
(215) 777-5825
Mailing address
PO BOX 22433, NEW YORK, NY 10087-2433
(215) 777-5808
(215) 777-5716
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
POD001150
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001150
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003118774A
—
GA
01
—
202I481075
INDIVIDUAL MEDICARE PTAN
GA
01
—
511G700902
GROUP MEDICARE PTAN
GA
Enumeration date
12/01/2010
Last updated
09/19/2023
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