Provider Demographics
NPI:1407290398
Name:BOWEN, GLENDA JEANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:JEANNETTE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLENDA
Other - Middle Name:JEANNETTE
Other - Last Name:EUCEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4124
Mailing Address - Country:US
Mailing Address - Phone:413-447-2695
Mailing Address - Fax:413-447-3111
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4124
Practice Address - Country:US
Practice Address - Phone:413-447-2695
Practice Address - Fax:413-447-3111
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054662207R00000X, 207RC0200X, 207RP1001X, 208M00000X
MA287531207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist