Healthcare Provider Details

I. General information

NPI: 1538158084
Provider Name (Legal Business Name): MARK G BOWIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 SALEM ST SUITE 7
GROVELAND MA
01834-1565
US

IV. Provider business mailing address

219 BEACH RD UNIT 11
SALISBURY MA
01952-2219
US

V. Phone/Fax

Practice location:
  • Phone: 978-420-1520
  • Fax: 978-420-1521
Mailing address:
  • Phone: 978-255-2864
  • Fax: 978-420-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76875
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: