Provider Demographics
NPI:1861553711
Name:LOWENTHAL, JONATHAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:LOWENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC0410005OtherCAREFIRST OF DC
MD4461101OtherAETNA NON-HMO
MD394841200Medicaid
MD2148224OtherAETNA PCP HMO
MD41717901OtherCAREFIRST OF MD
MD836798OtherOPTIMUM CH-MDIPA
MD110032509OtherRAILROAD MC
MD4461101OtherAETNA NON-HMO
MD394841200Medicaid