1972543247 NPI number — JED W LOWY APRN

Table of content: JED W LOWY APRN (NPI 1972543247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972543247 NPI number — JED W LOWY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWY
Provider First Name:
JED
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

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:
1972543247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05661-0749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-851-8603
Provider Business Mailing Address Fax Number:
802-851-8313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1878 MOUNTAIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOWE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-253-4853
Provider Business Practice Location Address Fax Number:
802-253-2587
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1010011353 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 053 19065 . This is a "VERMONT MANAGED CARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: ONP0514 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 362870 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 053 19065 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 6795901 . This is a "FLETCHER ALLEN PREFERRED" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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