Provider Demographics
NPI:1912938283
Name:LOWELL, CARLOS G III (DO)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:G
Last Name:LOWELL
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2525
Mailing Address - Country:US
Mailing Address - Phone:419-627-9289
Mailing Address - Fax:419-627-9294
Practice Address - Street 1:143 E WATER ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2525
Practice Address - Country:US
Practice Address - Phone:419-627-9289
Practice Address - Fax:419-627-9294
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340061472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160187Medicaid
OHLO0783771Medicare ID - Type Unspecified
OHG08568Medicare UPIN