Healthcare Provider Details

I. General information

NPI: 1851382535
Provider Name (Legal Business Name): MARVIN MCGOWAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 WOOD ST
CALIFORNIA PA
15419-1260
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-632-6801
  • Fax: 724-938-7853
Mailing address:
  • Phone: 724-632-6801
  • Fax: 724-632-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: