Provider Demographics
NPI:1124042684
Name:BOWEN, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 FOUNDATION WAY
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9003
Mailing Address - Country:US
Mailing Address - Phone:304-264-9080
Mailing Address - Fax:304-264-9082
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:SUITE 2400
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-264-9080
Practice Address - Fax:304-264-9082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12922207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083642000Medicaid
WV0083642000Medicaid
WV0562344Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID