Provider Demographics
NPI:1174549992
Name:LOURIE, IRA SANDERS (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:SANDERS
Last Name:LOURIE
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 1:18902 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2712
Mailing Address - Country:US
Mailing Address - Phone:301-733-2633
Mailing Address - Fax:301-733-7388
Practice Address - Street 1:18902 PRESTON RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2712
Practice Address - Country:US
Practice Address - Phone:301-733-2633
Practice Address - Fax:301-733-7388
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD152332084P0804X
MT83942084P0804X
NMMD2004-01512084P0804X
DEC1-0071742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEMD4393OtherCONTROLLED SUBSTANCE
MDM30831OtherCONTROLLED SUBSTANCE