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General NPI Number Information
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NPI Number | 1851382535
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Entity Type | Individual
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Provider Name | MARVIN MCGOWAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 1152 WOOD ST
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City | CALIFORNIA
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State | PA
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Zip | 15419-1260
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Country | US
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Telephone | 724-632-6801
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Fax | 724-938-7853
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Provider Business Mailing Address
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Address Line | 1070 OLD NATIONAL PIKE
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City | FREDERICKTOWN
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State | PA
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Zip | 15333-2114
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Country | US
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Telephone | 724-632-6801
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Fax | 724-632-6312
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS012547
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License Number State | PA
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