1821532813 NPI number — NEUROSCIENCE ASSOCIATES OF BOWIE

Table of content: LOWELL LYNN GARDNER MD (NPI 1396777520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821532813 NPI number — NEUROSCIENCE ASSOCIATES OF BOWIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSCIENCE ASSOCIATES OF BOWIE
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:
6
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:
1821532813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12416 SKYLARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20715-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-852-3479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14300 GALLANT FOX LN
Provider Second Line Business Practice Location Address:
107
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-852-3479
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON-HENRY
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-852-3479

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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