Provider Demographics
NPI:1720299456
Name:STOWE, KRENIE (MD)
Entity type:Individual
Prefix:DR
First Name:KRENIE
Middle Name:
Last Name:STOWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-4396
Mailing Address - Country:US
Mailing Address - Phone:978-686-0090
Mailing Address - Fax:978-683-0663
Practice Address - Street 1:700 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841
Practice Address - Country:US
Practice Address - Phone:978-686-0090
Practice Address - Fax:978-683-0663
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274183208000000X
ORMD160828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134227Medicaid
ORMD160828OtherOR MEDICAL LICENSE
ORR173356Medicare Oscar/Certification