Provider Demographics
NPI:1447218557
Name:MEYERSON, LOWELL D (DO)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:D
Last Name:MEYERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 TOWNSHIP LINE RD
Mailing Address - Street 2:STE 226
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2249
Mailing Address - Country:US
Mailing Address - Phone:215-379-0444
Mailing Address - Fax:215-663-1359
Practice Address - Street 1:50 E TOWNSHIP LINE RD
Practice Address - Street 2:STE 226
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-379-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005245L208C00000X
NJ25MB04161500208C00000X
FLOS8396208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA016225Medicaid
PA0053408000OtherKEYSTONE
PA016225Medicaid
B41857Medicare UPIN