Provider Demographics
NPI:1376087403
Name:DOW, OWEN (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:DOW
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:P.O. BOX 1362
Mailing Address - Street 2:6 WEDGEWOOD DRIVE
Mailing Address - City:GRANTHAN
Mailing Address - State:NH
Mailing Address - Zip Code:03753
Mailing Address - Country:US
Mailing Address - Phone:603-863-3317
Mailing Address - Fax:
Practice Address - Street 1:6 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GRANTHAN
Practice Address - State:NH
Practice Address - Zip Code:03753
Practice Address - Country:US
Practice Address - Phone:603-863-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD6485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery