Provider Demographics
NPI:1407983018
Name:SOWA, ROBERT F
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:F
Last Name:SOWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1347
Mailing Address - Country:US
Mailing Address - Phone:508-996-5631
Mailing Address - Fax:508-996-5711
Practice Address - Street 1:383 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1347
Practice Address - Country:US
Practice Address - Phone:508-996-5631
Practice Address - Fax:508-996-5711
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAHE-102-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1536702Medicaid