Provider Demographics
NPI:1093845455
Name:BOWLING, LADONNA RENAE (DO)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:RENAE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LADONNA
Other - Middle Name:RENAE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12301 GRAPEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BASTIAN
Mailing Address - State:VA
Mailing Address - Zip Code:24314-4547
Mailing Address - Country:US
Mailing Address - Phone:276-688-4331
Mailing Address - Fax:276-688-4336
Practice Address - Street 1:12301 GRAPEFIELD RD
Practice Address - Street 2:
Practice Address - City:BASTIAN
Practice Address - State:VA
Practice Address - Zip Code:24314-4547
Practice Address - Country:US
Practice Address - Phone:276-688-4331
Practice Address - Fax:276-688-4336
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2128207Q00000X
VA0102203420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00708546OtherRR MEDICARE
WV3810014072Medicaid
VA1104800671Medicaid
WVWV0404DMedicare Oscar/Certification
WVWV0404EMedicare Oscar/Certification
WVP00708546OtherRR MEDICARE
WVWO4253181OtherMEDICARE PTAN
WVWV0404B662Medicare Oscar/Certification
WVWV0404FMedicare Oscar/Certification
WVWV0404AMedicare PIN
WVWV0404IMedicare Oscar/Certification
WVWV0404BMedicare Oscar/Certification
WVWV0404CMedicare Oscar/Certification