Provider Demographics
NPI:1265616841
Name:LAREW, LOWELL (PA-C)
Entity type:Individual
Prefix:
First Name:LOWELL
Middle Name:
Last Name:LAREW
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MON HEALTH MEDICAL PARK DR STE 3201
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1135
Mailing Address - Country:US
Mailing Address - Phone:304-285-1460
Mailing Address - Fax:304-285-2739
Practice Address - Street 1:3000 MON HEALTH MEDICAL PARK DR STE 3201
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-285-1460
Practice Address - Fax:304-285-2739
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA30182Medicare PIN