Provider Demographics
NPI:1598075871
Name:LOWRIE, RYAN PAUL (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:LOWRIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1040
Mailing Address - Country:US
Mailing Address - Phone:607-770-0025
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:4433 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-771-2220
Practice Address - Fax:607-251-2635
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2022-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY014369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03280504Medicaid
NYJ400057374Medicare PIN
NY03280504Medicaid