Provider Demographics
NPI:1902826282
Name:LOWE, MERREDITH R
Entity Type:Individual
Prefix:
First Name:MERREDITH
Middle Name:R
Last Name:LOWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NW 14TH ST STE 410
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2115
Mailing Address - Country:US
Mailing Address - Phone:305-243-8834
Mailing Address - Fax:305-243-7668
Practice Address - Street 1:1150 NW 14TH ST STE 410
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2115
Practice Address - Country:US
Practice Address - Phone:305-243-8834
Practice Address - Fax:305-243-7668
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME719012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2514150-00Medicaid
FLG59975Medicare UPIN
FL2514150-00Medicaid