Provider Demographics
NPI:1316006638
Name:MODESTO LOWE, VANIA (MD)
Entity Type:Individual
Prefix:
First Name:VANIA
Middle Name:
Last Name:MODESTO LOWE
Suffix:
Gender:F
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:CONNECTICUT VALLEY HOSPITAL
Mailing Address - Street 2:1000 SILVER STREET - P.O. BOX 351 - 2ND FL
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-262-5868
Mailing Address - Fax:860-262-5055
Practice Address - Street 1:CONNECTICUT VALLEY HOSPITAL
Practice Address - Street 2:SILVER STREET
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5867
Practice Address - Fax:860-262-5850
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0339192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23725Medicare UPIN
26004106Medicare ID - Type UnspecifiedFIRST COAST