Provider Demographics
NPI:1265557185
Name:LOWE, EDWARD HATFIELD JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HATFIELD
Last Name:LOWE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:H
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 73
Mailing Address - Street 2:
Mailing Address - City:CITY ISLAND (BRONX)
Mailing Address - State:NY
Mailing Address - Zip Code:10464
Mailing Address - Country:US
Mailing Address - Phone:908-552-4405
Mailing Address - Fax:908-450-6195
Practice Address - Street 1:30 PILOT ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10464-1630
Practice Address - Country:US
Practice Address - Phone:908-552-4405
Practice Address - Fax:908-450-6195
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124708208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY124708OtherSTATE LICENSE
E62487Medicare UPIN
NY65F772Medicare PIN