Provider Demographics
NPI:1306853155
Name:MCGOWAN, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:MCGOWAN
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 1:55 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1913
Mailing Address - Country:US
Mailing Address - Phone:914-488-5757
Mailing Address - Fax:914-488-5755
Practice Address - Street 1:701 N BROADWAY
Practice Address - Street 2:PHELPS MEMORIAL HOSPITAL
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1020
Practice Address - Country:US
Practice Address - Phone:914-907-6583
Practice Address - Fax:914-488-5755
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156178208100000X
SCMD 34323208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
D91763Medicare UPIN
17F451Medicare ID - Type Unspecified