Healthcare Provider Details

I. General information

NPI: 1629343587
Provider Name (Legal Business Name): MICHELLE ANNE LOWES MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date: 09/24/2018
Reactivation Date: 10/31/2018

III. Provider practice location address

1250 WATERS PL
BRONX NY
10461-2720
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 866-633-8255
  • Fax: 929-263-3946
Mailing address:
  • Phone: 718-920-2680
  • Fax: 718-944-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number228412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: