Healthcare Provider Details

I. General information

NPI: 1801247630
Provider Name (Legal Business Name): NICHOLAS LOWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 TOWER OAKS BLVD # 345
ROCKVILLE MD
20852-4254
US

IV. Provider business mailing address

3206 TOWER OAKS BLVD # 345
ROCKVILLE MD
20852-4254
US

V. Phone/Fax

Practice location:
  • Phone: 716-329-7639
  • Fax: 240-250-1560
Mailing address:
  • Phone: 716-329-7639
  • Fax: 240-250-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number268357
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number115759-8905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: