Provider Demographics
NPI:1295747319
Name:LOEWEN, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:LOEWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LEWIS BAY RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5210
Mailing Address - Country:US
Mailing Address - Phone:508-775-0800
Mailing Address - Fax:508-771-8565
Practice Address - Street 1:40 LEWIS BAY RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5210
Practice Address - Country:US
Practice Address - Phone:508-775-0800
Practice Address - Fax:508-771-8565
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231062208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00427689OtherRAILROAD MEDICARE
2713608OtherUNITEDHEALTHCARE
AA82270OtherHPHC
MAJ41321OtherBC/BS
MA2133750Medicaid
1617292OtherCIGNA
MA496072OtherTUFTS
AA82270OtherHPHC
I60606Medicare UPIN