Provider Demographics
NPI:1275532251
Name:BOWERS, JAMELLE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMELLE
Middle Name:R
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 COUNTRYLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-1785
Mailing Address - Country:US
Mailing Address - Phone:804-240-0259
Mailing Address - Fax:513-389-4013
Practice Address - Street 1:3131 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2316
Practice Address - Country:US
Practice Address - Phone:513-389-5289
Practice Address - Fax:513-389-4013
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010272912Medicaid
VAP00283209OtherRAILROAD MEDICARE
VA188196OtherBLUE CROSS BLUE SHIELD
VA00W956P08Medicare ID - Type Unspecified
VAP00283209OtherRAILROAD MEDICARE