Healthcare Provider Details

I. General information

NPI: 1770591778
Provider Name (Legal Business Name): JOSEPH BOWEN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2008
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 Number
License Number State

VIII. Authorized Official

Name: JOSEPH J BOWEN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 203-591-3077