Healthcare Provider Details

I. General information

NPI: 1881874311
Provider Name (Legal Business Name): LAWRENCE P BOWEN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST SUITE 304
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

235 PLAIN ST SUITE 304
PROVIDENCE RI
02905-3240
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-4140
  • Fax: 401-331-0410
Mailing address:
  • Phone: 401-331-4140
  • Fax: 401-331-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number05305
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: