1760732218 NPI number — MR. CHESTER FRED BOWEN III MSCP

Table of content: MR. CHESTER FRED BOWEN III MSCP (NPI 1760732218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760732218 NPI number — MR. CHESTER FRED BOWEN III MSCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
CHESTER
Provider Middle Name:
FRED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
MSCP
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:
1760732218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 N BEACON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02134-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-782-8609
Provider Business Mailing Address Fax Number:
617-254-2882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 N. BEACON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-782-8609
Provider Business Practice Location Address Fax Number:
617-254-2882
Provider Enumeration Date:
09/12/2012

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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