Provider Demographics
NPI:1861456139
Name:LOWY, LEASA J (MD)
Entity Type:Individual
Prefix:
First Name:LEASA
Middle Name:J
Last Name:LOWY
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 1:17590 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6606
Mailing Address - Country:US
Mailing Address - Phone:360-410-0184
Mailing Address - Fax:
Practice Address - Street 1:1300 UNIVERSITY DR STE 8
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4254
Practice Address - Country:US
Practice Address - Phone:888-731-8991
Practice Address - Fax:833-775-1861
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042420174400000X, 207VG0400X
CAC186542207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1861456139Medicaid
WA7068105OtherAETNA
WA0078LOOtherREGENCE
WA0260481OtherL&I AND CRIME VICTIMS
WA0078LOOtherREGENCE
WA1861456139Medicaid