1376873109 NPI number — LOEW FAMILY MEDICAL PRACTICE, PLLC

Table of content: (NPI 1376873109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376873109 NPI number — LOEW FAMILY MEDICAL PRACTICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOEW FAMILY MEDICAL PRACTICE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376873109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 STILES RD
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-898-9834
Provider Business Mailing Address Fax Number:
603-898-8253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 STILES RD
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-898-9834
Provider Business Practice Location Address Fax Number:
603-898-8253
Provider Enumeration Date:
12/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOEW
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
ESTELLE
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
603-898-9834

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  6712 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0100891YPHN01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 725623 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1750364725 . This is a "NPI (PREVIOUS AS SOLE OWNER)" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: D19031 . This is a "BLUE CROSS BLUE SHEILD OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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