1235101445 NPI number — LAWRENCE P BOWEN MD INC

Table of content: (NPI 1235101445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235101445 NPI number — LAWRENCE P BOWEN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE P BOWEN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235101445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 PLAIN ST
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905-3241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-4140
Provider Business Mailing Address Fax Number:
401-331-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 PLAIN ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02905-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-331-4140
Provider Business Practice Location Address Fax Number:
401-331-0410
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWEN
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-331-4140

Provider Taxonomy Codes

  • Taxonomy code: 2082S0099X , with the licence number:  RI5305 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: RI5305 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0105X , with the licence number: RI5305 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: RI5305 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000759 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4000248 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 30202009 . This is a "MASS BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 300042 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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