MEDICARE: DR. DAVID E SOWA M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	029591	CT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	160031240	OTHER	CT	RAIL ROAD MEDICARE
10	368793	OTHER	CT	WELLCARE MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1255448144	OTHER	CT	GHMC GROUP NPI ID
3	482005	OTHER	CT	AETNA
4	P369836	OTHER	CT	OXFORD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	01029591	OTHER	CT	CIGNA
8	010029591CT01	OTHER	CT	BCBS & BCFP ID
9	2959101	OTHER	CT	CONNECTICARE
11	060027	OTHER	CT	HEALTH NET

NPI Number	:	1104813377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID E SOWA M.D.

Provider Business Mailing Address
First Line	:	300 KENSINGTON AVE
Second Line	:	GROVE HILL MEDICAL CENTER
City	:	NEW BRITAIN
State	:	CT
Zip	:	06051-3916
Country	:	US
Telephone Number	:	860-747-0730
Fax Number	:	860-747-2028

Provider Business Practice Location Address
First Line	:	184 EAST ST
Second Line	:	GROVE HILL MEDICAL CENTER
City	:	PLAINVILLE
State	:	CT
Zip	:	06062-2913
Country	:	US
Telephone Number	:	860-747-0730
Fax Number	:	860-747-2028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/09/2007

184 EAST ST
PLAINVILLE, CT
06062-2913

Practice Phone: 860-747-1132
Practice Fax: 860-747-2028

184 EAST ST
PLAINVILLE, CT
06062-2913