Provider Demographics
NPI:1326214693
Name:BOWLING, BENJAMIN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:BOWLING
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 1:202 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:10012
Mailing Address - Country:UM
Mailing Address - Phone:212-343-3040
Mailing Address - Fax:212-343-3036
Practice Address - Street 1:202 SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3645
Practice Address - Country:US
Practice Address - Phone:212-343-3040
Practice Address - Fax:212-343-3036
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400068565Medicare PIN