Healthcare Provider Details

I. General information

NPI: 1306157441
Provider Name (Legal Business Name): VICKI ROBIN MCGOWAN II D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S TOLLGATE RD SUITE 200
BEL AIR MD
21015-5903
US

IV. Provider business mailing address

649 POSSUM TROT WAY
ABERDEEN MD
21001-2658
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-9533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH77808
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: