Provider Demographics
NPI:1205815032
Name:BOWEN, MARC XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:XAVIER
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4001
Mailing Address - Country:US
Mailing Address - Phone:212-480-4062
Mailing Address - Fax:646-582-1434
Practice Address - Street 1:209 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4001
Practice Address - Country:US
Practice Address - Phone:212-480-4062
Practice Address - Fax:646-582-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197205207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01537282Medicaid
NYF99112Medicare UPIN
NYA400086193Medicare PIN