MEDICARE: NICHOLAS LOWE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	115759-8905	UT
2	207R00000X	Internal Medicine Physician	268357	MA

General Provider Information

NPI Number	:	1801247630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS LOWE

Provider Business Mailing Address
First Line	:	330 MOUNT AUBURN ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5502
Country	:	US
Telephone Number	:	617-492-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5373 W LAKE PARK BLVD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-8208
Country	:	US
Telephone Number	:	801-902-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	05/01/2024

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Directions to “ NICHOLAS LOWE ” Practice Location

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