Basic Information
| Provider Information | |||||||||
| NPI: | 1720057797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNAPOLIS CENTER FOR INTEGRATIVE MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212640001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102806573 | ||||||||
| FaxNumber: | 4102806515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2009 TIDEWATER COLONY WAY | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214012127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102240010 | ||||||||
| FaxNumber: | 4102240012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOWE | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4102240010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.