=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235496258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROWEN OPHTHALMOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2012
-----------------------------------------------------
Last Update Date | 04/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7602 BELAIR RD
-----------------------------------------------------
City | NOTTINGHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-4088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-821-5333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7602 BELAIR RD
-----------------------------------------------------
City | NOTTINGHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21236-4088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-821-5333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTORE
-----------------------------------------------------
Name | SHERI LYNN ROWEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-821-5333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D0029764
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------