Healthcare Provider Details

I. General information

NPI: 1093931255
Provider Name (Legal Business Name): ROBERT E. BOWEN, MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOUNDATION WAY SUITE 2400
MARTINSBURG WV
25401-2400
US

IV. Provider business mailing address

2000 FOUNDATION WAY SUITE 2400
MARTINSBURG WV
25401-2400
US

V. Phone/Fax

Practice location:
  • Phone: 304-264-9080
  • Fax: 304-264-9082
Mailing address:
  • Phone: 304-264-9080
  • Fax: 304-264-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number12922
License Number StateWV

VIII. Authorized Official

Name: DR. ROBERT E BOWEN
Title or Position: DOCTOR
Credential: MD
Phone: 304-264-9080