Provider Demographics
NPI:1508815069
Name:ROWE, JOHN ROGER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROGER
Last Name:ROWE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-5101
Practice Address - Fax:843-606-7997
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080180922OtherRR MEDICARE
SCT66130Medicaid
SC080180706OtherRR MEDICARE
SCP00727255OtherRAILROAD MEDICARE ID-RSFPN
SCH340406795Medicare PIN
SCH340409223Medicare PIN
SC080180706OtherRR MEDICARE
SC080180922OtherRR MEDICARE
SCH34040Medicare UPIN
SCT66130Medicaid