Provider Demographics
NPI:1467461806
Name:JOHN J BOWDEN JR DO PC
Entity Type:Organization
Organization Name:JOHN J BOWDEN JR DO PC
Other - Org Name:WEST OAK LANE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-548-3403
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA133193Medicare PIN