Healthcare Provider Details

I. General information

NPI: 1457551707
Provider Name (Legal Business Name): KATIE LOVE BOWER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE M. LOVE

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

IV. Provider business mailing address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5170
  • Fax: 540-983-8212
Mailing address:
  • Phone: 540-224-5170
  • Fax: 540-983-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101254061
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: