Healthcare Provider Details

I. General information

NPI: 1245728807
Provider Name (Legal Business Name): STEFAN ERIC LOWENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MILLER AVE
MILL VALLEY CA
94941-2905
US

IV. Provider business mailing address

535 MILLER AVE
MILL VALLEY CA
94941-2905
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-5475
  • Fax: 415-383-1275
Mailing address:
  • Phone: 415-383-5475
  • Fax: 415-383-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA165056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA165056
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA165056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: