Healthcare Provider Details

I. General information

NPI: 1679555114
Provider Name (Legal Business Name): PATRICK J LOWRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

633 W MAIN ST
MOUNT PLEASANT PA
15666-1846
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-5000
  • Fax: 616-455-5960
Mailing address:
  • Phone: 724-542-4059
  • Fax: 724-542-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberEMC0003298
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0103270
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8188-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD491669C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: