Provider Demographics
NPI:1528053949
Name:KALLEN, LOWELL H (MD)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:H
Last Name:KALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2816
Mailing Address - Country:US
Mailing Address - Phone:757-371-6772
Mailing Address - Fax:866-203-2138
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2816
Practice Address - Country:US
Practice Address - Phone:888-316-5221
Practice Address - Fax:866-203-2138
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0295732084P0800X
VA01012344432084P0800X, 2084P0804X
CT295732084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010087465Medicaid
VA004945310OtherVIRGINIA PREMIER
VA142810OtherTRIGON BCBS/HEALTHKEEPERS
VAO84586MOtherOPTIMA FAMILY CARE
VA010087465Medicaid
VAO84586MOtherOPTIMA FAMILY CARE