1619036597 NPI number — DR. MICHAEL G BOWERS DO

Table of content: DR. MICHAEL G BOWERS DO (NPI 1619036597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619036597 NPI number — DR. MICHAEL G BOWERS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWERS
Provider First Name:
MICHAEL
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1619036597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 791128
Provider Second Line Business Mailing Address:
LL20
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21279-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-391-2030
Provider Business Mailing Address Fax Number:
703-273-3943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12110 SUNSET HILLS ROAD
Provider Second Line Business Practice Location Address:
LL20
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-834-1473
Provider Business Practice Location Address Fax Number:
703-318-7463
Provider Enumeration Date:
12/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0102201349 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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