Healthcare Provider Details

I. General information

NPI: 1174123905
Provider Name (Legal Business Name): NATHAN ANDREW MCGOWAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EDWARDS RD STE 300
CINCINNATI OH
45209-1288
US

IV. Provider business mailing address

PO BOX 643398
CINCINNATI OH
45264-3398
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-1100
  • Fax: 513-684-4501
Mailing address:
  • Phone: 513-221-1100
  • Fax: 513-569-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009614RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.009614RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: