Basic Information
| Provider Information | |||||||||
| NPI: | 1356377675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWTHER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 BLAZIER DR | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781152 | ||||||||
| FaxNumber: | 4126056669 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 BLAZIER DR | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781152 | ||||||||
| FaxNumber: | 4126056669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | MD428600 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1022567150001 | 05 | PA | MEDICAID |