Healthcare Provider Details

I. General information

NPI: 1679581672
Provider Name (Legal Business Name): JOSEPH J BOWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CHASE PKWY SUITE A
WATERBURY CT
06708-2948
US

IV. Provider business mailing address

1075 CHASE PKWY SUITE A
WATERBURY CT
06708-2948
US

V. Phone/Fax

Practice location:
  • Phone: 203-591-3077
  • Fax: 203-591-3074
Mailing address:
  • Phone: 203-591-3077
  • Fax: 203-591-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number025522
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: