Healthcare Provider Details

I. General information

NPI: 1700371937
Provider Name (Legal Business Name): LISSA HEWAN-LOWE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

IV. Provider business mailing address

8268 164TH ST
JAMAICA NY
11432-1121
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4095
  • Fax: 864-725-5082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number90079
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: