Provider Demographics
NPI:1376873109
Name:LOEW FAMILY MEDICAL PRACTICE, PLLC
Entity Type:Organization
Organization Name:LOEW FAMILY MEDICAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ESTELLE
Authorized Official - Last Name:LOEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-898-9834
Mailing Address - Street 1:23 STILES RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2859
Mailing Address - Country:US
Mailing Address - Phone:603-898-9834
Mailing Address - Fax:603-898-8253
Practice Address - Street 1:23 STILES RD
Practice Address - Street 2:SUITE 213
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2859
Practice Address - Country:US
Practice Address - Phone:603-898-9834
Practice Address - Fax:603-898-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6712261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0100891YPHN01OtherANTHEM
NH725623OtherTUFTS
NH1750364725OtherNPI (PREVIOUS AS SOLE OWNER)
MAD19031OtherBLUE CROSS BLUE SHEILD OF MASSACHUSETTS
NHC65863Medicare UPIN
NHNH0891Medicare PIN