Provider Demographics
NPI:1558308502
Name:LOWERY, SUPNA BHAGAT (MD)
Entity Type:Individual
Prefix:
First Name:SUPNA
Middle Name:BHAGAT
Last Name:LOWERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 JOSEPH SIEWICK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1764
Mailing Address - Country:US
Mailing Address - Phone:877-511-4625
Mailing Address - Fax:571-665-6877
Practice Address - Street 1:3580 JOSEPH SIEWICK DR STE 203
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1764
Practice Address - Country:US
Practice Address - Phone:877-511-4625
Practice Address - Fax:571-665-6877
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237047207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10045657OtherSENTARA/OPTIMA HEALTH
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
VA1558308502Medicaid
VAPAROtherAETNA
VA373539OtherANTHEM BC/BS
VAPAROtherVA PREMIER HEALTH
VAPAROtherCIGNA
VA-033OtherTRICARE/CHAMPUS
NC11891OtherBC/BS OF NORTH CAROLINA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC5911891Medicaid
VAPAROtherCORVEL/CORCARE
VA020065E30Medicare PIN