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General NPI Number Information
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NPI Number | 1306288816
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Entity Type | Individual
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Provider Name | SHANE MATTHEW MCGOWAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 7650 EAST PARHAM ROAD SUITE 100
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City | RICHMOND
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State | VA
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Zip | 23294
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Country | US
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Telephone | 804-288-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 860 OMNI BLVD STE 101
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4430
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Country | US
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Telephone | 757-232-8769
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Fax | 757-232-8875
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MT204834
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101266708
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License Number State | VA
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