Provider Demographics
NPI:1205406865
Name:LOWER, ALEX (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:LOWER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CORNERSTONE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5361
Mailing Address - Country:US
Mailing Address - Phone:240-416-8643
Mailing Address - Fax:
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2022-08-30
Deactivation Date:2022-07-28
Deactivation Code:
Reactivation Date:2022-08-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0110-008160363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program