Provider Demographics
NPI:1154495414
Name:MCGOWAN, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2100 KEYSTONE AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1129
Mailing Address - Country:US
Mailing Address - Phone:610-259-3000
Mailing Address - Fax:610-259-3042
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1129
Practice Address - Country:US
Practice Address - Phone:610-259-3000
Practice Address - Fax:610-259-3042
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025981E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001031440Medicaid
PA001031440Medicaid
PA184489Medicare ID - Type Unspecified