Provider Demographics
NPI:1447200258
Name:BOWDEN, JOHN J JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BOWDEN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-1546
Mailing Address - Country:US
Mailing Address - Phone:215-548-3390
Mailing Address - Fax:215-549-8998
Practice Address - Street 1:1738 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-1546
Practice Address - Country:US
Practice Address - Phone:215-548-3390
Practice Address - Fax:215-549-8998
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004458-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006281490002Medicaid
PA006281490002Medicaid
PA147099ZA2MMedicare PIN