Provider Demographics
NPI:1164527693
Name:BOWEN, JOHN CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
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 1:792 N MAIN ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1661
Mailing Address - Country:US
Mailing Address - Phone:315-423-9722
Mailing Address - Fax:315-423-9687
Practice Address - Street 1:770 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2117
Practice Address - Country:US
Practice Address - Phone:315-422-2222
Practice Address - Fax:315-472-8497
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188947207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350027Medicaid
NYC64674Medicare UPIN
NY01350027Medicaid