Healthcare Provider Details

I. General information

NPI: 1568824902
Provider Name (Legal Business Name): AMANDA C BOWERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA C WORD

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ATLANTIC AVE
MARBLEHEAD MA
01945-3098
US

IV. Provider business mailing address

70 ATLANTIC AVE
MARBLEHEAD MA
01945-3098
US

V. Phone/Fax

Practice location:
  • Phone: 781-631-7800
  • Fax: 781-631-4319
Mailing address:
  • Phone: 781-631-7800
  • Fax: 781-631-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number279201
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD23166
Identifier TypeOTHER
Identifier StateME
Identifier IssuerSTATE LICENSE
# 2
IdentifierMCSR005248A
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMCSR
# 3
Identifier14523875
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH
# 4
Identifier279201
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerSTATE LICENSE
# 5
Identifier042.0014718
Identifier TypeOTHER
Identifier StateVT
Identifier IssuerSTATE LICENSE
# 6
Identifier1470576
Identifier TypeOTHER
Identifier State
Identifier IssuerAAP
# 7
Identifier1015844
Identifier TypeOTHER
Identifier State
Identifier IssuerABP
# 8
Identifier470641
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: