Provider Demographics
NPI:1194034694
Name:BOWMAN, MEGHAN BISSELL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:BISSELL
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MISS
Other - First Name:MEGHAN
Other - Middle Name:MARY
Other - Last Name:BISSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:450 CRESSON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-728-6100
Mailing Address - Fax:610-728-6071
Practice Address - Street 1:450 CRESSON BOULEVARD
Practice Address - Street 2:
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-728-6100
Practice Address - Fax:610-728-6071
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02462363A00000X
PAMA057013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762604Medicare PIN