Provider Demographics
NPI:1952521635
Name:LOWE, MARK V (PA C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:V
Last Name:LOWE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:1858 W 54TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002
Mailing Address - Country:US
Mailing Address - Phone:303-895-9536
Mailing Address - Fax:
Practice Address - Street 1:3655 LUTHERAN PKWY
Practice Address - Street 2:STE 301 PEDIATRICS WEST
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:720-284-3700
Practice Address - Fax:303-421-3822
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1055154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44659237Medicaid