Individual
DR. IVAN STEPHEN LOWENTHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
633 GOV CARLOS CAMACHO RD., STE B5, TAMUNING, GU 96913-3194
(671) 647-4656
(671) 647-4660
Mailing address
633 GOV CARLOS CAMACHO RD., STE B5, TAMUNING, GU 96913-3194
(671) 647-4656
(671) 647-4660
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
18789
CT
207RX0202X
Medical Oncology Physician
Primary
M-1925
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001187897
—
CT
01
—
06-1088532
TAX ID #
—
01
—
1683
CT CONTROLLED SUBSTANCE
CT
01
—
18789
CT. LICENSE
CT
01
—
M-1925
GUAM LICENSE
GU
Enumeration date
07/11/2006
Last updated
03/19/2025
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