Provider Demographics
NPI:1225059611
Name:BOWEN, ROBERT CALVIN III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CALVIN
Last Name:BOWEN
Suffix:III
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 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:704-495-6334
Mailing Address - Fax:704-817-7219
Practice Address - Street 1:6060 PIEDMONT ROW DR S FL 7
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287
Practice Address - Country:US
Practice Address - Phone:704-489-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00006207R00000X
SC86633207R00000X
NC200200006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1225059611Medicaid
NC1307VOtherBCBSNC
NCP00360428OtherRAILROAD MEDICARE
SCN00006Medicaid
NC891307VMedicaid
NC2002358Medicare PIN
NCP00360428OtherRAILROAD MEDICARE
SCN00006Medicaid
NCH67357Medicare UPIN
NC1225059611Medicaid
NCNCH379AMedicare PIN
NC2002358CMedicare PIN