Healthcare Provider Details

I. General information

NPI: 1841401247
Provider Name (Legal Business Name): THOMAS E. BOWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 NEWBURY ST
PORTLAND ME
04101-4261
US

IV. Provider business mailing address

12 LOWER MAST LANDING RD
FREEPORT ME
04032-6407
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-0058
  • Fax:
Mailing address:
  • Phone: 207-865-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0004
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: