Provider Demographics
NPI:1841510161
Name:LOWE, GILLIAN KAYE (MD)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:KAYE
Last Name:LOWE
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 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6480
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:3169 BRAVERTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2679
Practice Address - Country:US
Practice Address - Phone:410-956-4911
Practice Address - Fax:410-956-4939
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022584207Q00000X
MDD75974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD067229700Medicaid
MDK6430006OtherBCBS
MD067229700Medicaid
MDP01322492Medicare PIN