Healthcare Provider Details

I. General information

NPI: 1326013350
Provider Name (Legal Business Name): CHARITY MUTHONI FINUCANE BOWCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY MUTHON FINUCANE MD

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 W GRANADA BLVD #2B
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

4138 BROOKMYRA DRIVE
ORLANDO FL
32837
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-3530
  • Fax: 386-673-1933
Mailing address:
  • Phone: 386-679-1114
  • Fax: 407-826-4136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number65822
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME65822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: