=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093931255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT E. BOWEN, MD, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 FOUNDATION WAY SUITE 2400
-----------------------------------------------------
City | MARTINSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25401-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-264-9080
-----------------------------------------------------
Fax | 304-264-9082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 FOUNDATION WAY SUITE 2400
-----------------------------------------------------
City | MARTINSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25401-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-264-9080
-----------------------------------------------------
Fax | 304-264-9082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. ROBERT E BOWEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 304-264-9080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 12922
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------