MEDICARE: GARY MCGOWAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	0101039727	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C09637	OTHER		MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1497715478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MCGOWAN MD

Provider Business Mailing Address
First Line	:	PO BOX 11768
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-0168
Country	:	US
Telephone Number	:	804-353-4000
Fax Number	:	804-213-9783

Provider Business Practice Location Address
First Line	:	2621 GROVE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4308
Country	:	US
Telephone Number	:	804-254-5467
Fax Number	:	804-254-9898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/17/2007

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