Healthcare Provider Details

I. General information

NPI: 1447200258
Provider Name (Legal Business Name): JOHN J BOWDEN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 W CHELTENHAM AVE
PHILADELPHIA PA
19126-1546
US

IV. Provider business mailing address

1738 W CHELTENHAM AVE
PHILADELPHIA PA
19126-1546
US

V. Phone/Fax

Practice location:
  • Phone: 215-548-3390
  • Fax: 215-549-8998
Mailing address:
  • Phone: 215-548-3390
  • Fax: 215-549-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004458-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: