Healthcare Provider Details

I. General information

NPI: 1770872285
Provider Name (Legal Business Name): BENJAMIN MAULDIN LOWENBURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 CANAL ST TB-53
NEW ORLEANS LA
70112-2703
US

IV. Provider business mailing address

1440 CANAL ST TB-53
NEW ORLEANS LA
70112-2703
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4272
  • Fax:
Mailing address:
  • Phone: 504-988-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD.206092
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: