Provider Demographics
NPI:1558699504
Name:LOWELL D. MEYERSON DO, PC
Entity Type:Organization
Organization Name:LOWELL D. MEYERSON DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-379-0710
Mailing Address - Street 1:50 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE G02
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 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE G02
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2249
Practice Address - Country:US
Practice Address - Phone:215-379-0444
Practice Address - Fax:215-663-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053408000OtherKEYSTONE HEALTH PLAN EAST
PA016225Medicaid
PAME440629Medicare PIN