Provider Demographics
NPI:1326013350
Name:FINUCANE BOWCHER, CHARITY MUTHONI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:MUTHONI
Last Name:FINUCANE BOWCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:MUTHON
Other - Last Name:FINUCANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4138 BROOKMYRA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:386-679-1114
Mailing Address - Fax:407-826-4136
Practice Address - Street 1:1688 W GRANADA BLVD
Practice Address - Street 2:#2B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-677-3530
Practice Address - Fax:386-673-1933
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65822208000000X
FLME65822208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375434101Medicaid
FL375434101Medicaid
28419ZMedicare ID - Type Unspecified