Provider Demographics
NPI:1497706642
Name:TONG, LOWELL D (MD)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:D
Last Name:TONG
Suffix:
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 1:401 PARNASSUS AVE
Mailing Address - Street 2:BOX MSE-0984
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0984
Mailing Address - Country:US
Mailing Address - Phone:415-475-7469
Mailing Address - Fax:415-476-7163
Practice Address - Street 1:401 PARNASSUS AVE
Practice Address - Street 2:BOX MSE-0984
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0984
Practice Address - Country:US
Practice Address - Phone:415-476-7469
Practice Address - Fax:415-476-7163
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG523142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G523140Medicaid
CA00G523140Medicaid
CAA52231Medicare UPIN