Provider Demographics
NPI:1043245889
Name:LOWENTHAL, IVAN STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:STEPHEN
Last Name:LOWENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-6820
Mailing Address - Country:US
Mailing Address - Phone:860-307-3393
Mailing Address - Fax:
Practice Address - Street 1:6 DEVINE ST STE 2C
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2222
Practice Address - Country:US
Practice Address - Phone:203-407-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18789207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1683OtherCT CONTROLLED SUBSTANCE
CT001187897Medicaid
CT18789OtherCT. LICENSE
06-1088532OtherTAX ID #
06-1088532OtherTAX ID #
CTCD0030Medicare PIN
CT001187897Medicaid
AL7584027OtherDEA
B84132Medicare UPIN
490000139Medicare ID - Type Unspecified