Healthcare Provider Details

I. General information

NPI: 1205367463
Provider Name (Legal Business Name): BOWIE INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14999 HEALTH CENTER DR SUITE 201
BOWIE MD
20716-1074
US

IV. Provider business mailing address

14999 HEALTH CENTER DR SUITE 201
BOWIE MD
20716-1074
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-8188
  • Fax: 301-464-8233
Mailing address:
  • Phone: 301-262-8188
  • Fax: 301-464-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MCCONKEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-262-8188