Healthcare Provider Details

I. General information

NPI: 1740416221
Provider Name (Legal Business Name): KIMBERLY C BOWMAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 07/13/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S. 9TH STREET SUITE 204
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

33 S. 9TH STREET SUITE 204
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-0152
  • Fax:
Mailing address:
  • Phone: 215-955-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD467977
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number277981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: