Provider Demographics
NPI:1700888518
Name:LOWRY, KATIE (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LOWRY
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:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1466
Mailing Address - Country:US
Mailing Address - Phone:910-674-4203
Mailing Address - Fax:910-674-4213
Practice Address - Street 1:3001 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2984
Practice Address - Country:US
Practice Address - Phone:910-674-4203
Practice Address - Fax:910-674-4213
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300493208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134J4OtherBCBS PROVIDER NUMBER
NC89134J4Medicaid
NCC7593OtherMEDCOST PROVIDER NUMBER
NC7698441OtherAETNA PROVIDER NUMBER
NCC7593OtherMEDCOST PROVIDER NUMBER