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General NPI Number Information
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NPI Number | 1235117169
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Entity Type | Individual
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Provider Name | ARCHIE R MCGOWAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 175 FORE RIVER PKWY
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City | PORTLAND
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State | ME
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Zip | 04102-2779
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Country | US
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Telephone | 207-879-3000
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Fax | 207-777-1439
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Provider Business Mailing Address
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Address Line | PO BOX 986520 DEPARTMENT 250
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City | BOSTON
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State | MA
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Zip | 02298-6520
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Country | US
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Telephone | 207-784-2554
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Fax | 207-777-1439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 154492
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 11784
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11784
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 154492
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD27493
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License Number State | ME
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