Provider Demographics
NPI:1427384189
Name:LOWE, MARY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:LOWE
Suffix:
Gender:F
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 1:1315 EAST BLVD UNIT 614
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6076
Mailing Address - Country:US
Mailing Address - Phone:703-581-4860
Mailing Address - Fax:
Practice Address - Street 1:3101 LATROBE DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4849
Practice Address - Country:US
Practice Address - Phone:330-445-4361
Practice Address - Fax:330-451-4197
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant