Provider Demographics
NPI:1225159098
Name:MCGOWAN, SEAN (CO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 C EXECUTIVE PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28734-3768
Mailing Address - Country:US
Mailing Address - Phone:252-752-2324
Mailing Address - Fax:252-752-2425
Practice Address - Street 1:2301 C EXECUTIVE PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:28734-3768
Practice Address - Country:US
Practice Address - Phone:252-752-2324
Practice Address - Fax:252-752-2425
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795269Medicaid