Healthcare Provider Details

I. General information

NPI: 1598717654
Provider Name (Legal Business Name): PHILIP N MOWREY PH.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 NEWBROOK DR POB 10841
CHANTILLY VA
20151-2228
US

IV. Provider business mailing address

14225 NEWBROOK DR POB 10841
CHANTILLY VA
20151-2228
US

V. Phone/Fax

Practice location:
  • Phone: 703-802-7094
  • Fax: 703-802-7103
Mailing address:
  • Phone: 703-802-7094
  • Fax: 703-802-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberMOWRP1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: