Provider Demographics
NPI:1720057797
Name:ANNAPOLIS CENTER FOR INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:ANNAPOLIS CENTER FOR INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-224-0010
Mailing Address - Street 1:PO BOX
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-0001
Mailing Address - Country:US
Mailing Address - Phone:410-280-6573
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2009 TIDEWATER COLONY WAY
Practice Address - Street 2:SUITE 2A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2127
Practice Address - Country:US
Practice Address - Phone:410-224-0010
Practice Address - Fax:410-224-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD952LMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER