Healthcare Provider Details

I. General information

NPI: 1700810603
Provider Name (Legal Business Name): RICHARD G BOWMAN II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ORTHOPEDIC WAY
MORGANTOWN WV
26505-1240
US

IV. Provider business mailing address

100 PEYTON WAY STE 200
CHARLESTON WV
25309-8545
US

V. Phone/Fax

Practice location:
  • Phone: 681-214-5399
  • Fax: 304-241-5167
Mailing address:
  • Phone: 904-638-6147
  • Fax: 904-638-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20316
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20316
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: