=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154991701
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW LOWERY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2021
-----------------------------------------------------
Last Update Date | 07/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3509 N BROAD ST FL 5
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-730-9685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1032 BLACKSMITH LN
-----------------------------------------------------
City | COLLEGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-744-8861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MT222771
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------