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General NPI Number Information
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NPI Number | 1043245889
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Entity Type | Individual
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Provider Name | IVAN STEPHEN LOWENTHAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 633 GOV CARLOS CAMACHO RD., STE B5
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City | TAMUNING
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State | GU
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Zip | 96913-3194
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Country | US
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Telephone | 671-647-4656
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Fax | 671-647-4660
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Provider Business Mailing Address
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Address Line | 633 GOV CARLOS CAMACHO RD., STE B5
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City | TAMUNING
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State | GU
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Zip | 96913-3194
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Country | US
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Telephone | 671-647-4656
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Fax | 671-647-4660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 18789
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | M-1925
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License Number State | GU
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