Provider Demographics
NPI:1346296621
Name:MCDOWELL, GLADSTONE C II (MD)
Entity Type:Individual
Prefix:
First Name:GLADSTONE
Middle Name:C
Last Name:MCDOWELL
Suffix:II
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 1:1210 GEMINI PL
Mailing Address - Street 2:STE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6109
Mailing Address - Country:US
Mailing Address - Phone:614-383-6450
Mailing Address - Fax:
Practice Address - Street 1:1210 GEMINI PL
Practice Address - Street 2:STE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6109
Practice Address - Country:US
Practice Address - Phone:614-383-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049763207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093354Medicaid
OHMC0861167Medicare PIN
OHMC0861168Medicare PIN
MC0861161Medicare ID - Type Unspecified
E01242Medicare UPIN