Provider Demographics
NPI:1083641252
Name:BOWDEN, MARCIA R (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:R
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2508
Mailing Address - Country:US
Mailing Address - Phone:901-278-9538
Mailing Address - Fax:901-726-9883
Practice Address - Street 1:1652 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2508
Practice Address - Country:US
Practice Address - Phone:901-278-9538
Practice Address - Fax:901-726-9883
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29971170100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG75309Medicare UPIN
TN3821651Medicare ID - Type Unspecified