Provider Demographics
NPI:1487657102
Name:BOWENS, CHRISTOPHER A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:BOWENS
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 1:1400 PEOPLES PLZ STE 111
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5706
Mailing Address - Country:US
Mailing Address - Phone:302-834-3700
Mailing Address - Fax:302-834-8330
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-834-3700
Practice Address - Fax:302-834-8330
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002916207RC0000X
DEC1-0002916207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000200201Medicaid
DEE23693Medicare UPIN
E23693Medicare UPIN
DE580886D12Medicare PIN