Provider Demographics
NPI:1285637405
Name:MCGOWEN, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MCGOWEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2097
Practice Address - Country:US
Practice Address - Phone:508-273-4950
Practice Address - Fax:508-273-4951
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA60222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110047380AMedicaid
MAJ0877401Medicare PIN
MA0401215OtherUNITED HEALTHCARE
MA6745OtherHARVARD PILGRIM HEALTH PL
MA3290902OtherAETNA INSURANCE
MA3052176Medicaid
MA060222OtherTUFTS HEALTH PLAN
MAP000579229OtherRAILROAD MEDICARE
MAM21308Medicare ID - Type Unspecified