Healthcare Provider Details

I. General information

NPI: 1780777458
Provider Name (Legal Business Name): MILAGRO CARMEN ESCOBAR-BOWLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 GIRARD ST STE 100
GAITHERSBURG MD
20877-3467
US

IV. Provider business mailing address

220 GIRARD ST # 100
GAITHERSBURG MD
20877-3467
US

V. Phone/Fax

Practice location:
  • Phone: 301-216-0880
  • Fax: 301-216-2891
Mailing address:
  • Phone: 301-216-0880
  • Fax: 301-216-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0056980
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: