Provider Demographics
NPI:1891990511
Name:BRUCE M LOWRIE MD INC
Entity Type:Organization
Organization Name:BRUCE M LOWRIE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-625-1036
Mailing Address - Street 1:23250 CHAGRIN BLVD
Mailing Address - Street 2:STE # 150
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5470
Mailing Address - Country:US
Mailing Address - Phone:216-625-1036
Mailing Address - Fax:216-896-0766
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:STE # 150
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5470
Practice Address - Country:US
Practice Address - Phone:216-625-1036
Practice Address - Fax:216-896-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-054459207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776905Medicaid
OHE41709Medicare UPIN
OH0776905Medicaid