Healthcare Provider Details

I. General information

NPI: 1235101445
Provider Name (Legal Business Name): LAWRENCE P BOWEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST SUITE 304
PROVIDENCE RI
02905-3241
US

IV. Provider business mailing address

235 PLAIN ST SUITE 304
PROVIDENCE RI
02905-3241
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 TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberRI5305
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberRI5305
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberRI5305
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberRI5305
License Number StateRI

VIII. Authorized Official

Name: LAWRENCE P BOWEN
Title or Position: PRESIDENT
Credential: MD
Phone: 401-331-4140