Healthcare Provider Details

I. General information

NPI: 1841510161
Provider Name (Legal Business Name): GILLIAN KAYE LOWE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 BRAVERTON ST SUITE 201
EDGEWATER MD
21037-2679
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-4911
  • Fax: 410-956-4939
Mailing address:
  • Phone: 443-481-6480
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116022584
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD75974
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: