Provider Demographics
NPI:1710512777
Name:FLUDD, LOWELL WALSH
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:WALSH
Last Name:FLUDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20757-1628
Mailing Address - Country:US
Mailing Address - Phone:240-501-6441
Mailing Address - Fax:
Practice Address - Street 1:7101 SOUTHLAWN DR
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2166
Practice Address - Country:US
Practice Address - Phone:240-501-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)