Provider Demographics
NPI:1417055716
Name:LOWE, CARL JARRETT JR (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JARRETT
Last Name:LOWE
Suffix:JR
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 1:2104 RANDOLPH ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1522
Mailing Address - Country:US
Mailing Address - Phone:704-377-3900
Mailing Address - Fax:704-377-1244
Practice Address - Street 1:2104 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1522
Practice Address - Country:US
Practice Address - Phone:704-377-3900
Practice Address - Fax:704-377-1244
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200948208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131PTMedicaid
NC131PTOtherBLUE CROSS & BLUE SHIELD
NC89131PTMedicaid
NC2005566Medicare ID - Type Unspecified