Provider Demographics
NPI: | 1548203904 |
---|---|
Name: | ROWEN, SHERI L (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SHERI |
Middle Name: | L |
Last Name: | ROWEN |
Suffix: | |
Gender: | F |
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: | 4220 VON KARMAN AVE |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | NEWPORT BEACH |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92660-2044 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 949-854-7400 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4220 VON KARMAN AVE |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | NEWPORT BEACH |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92660-2044 |
Practice Address - Country: | US |
Practice Address - Phone: | 949-854-7400 |
Practice Address - Fax: | 949-234-8295 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-14 |
Last Update Date: | 2016-06-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D29764 | 207W00000X |
CA | C131504 | 207W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 511805101 | Medicaid | |
293L / 293L | Medicare ID - Type Unspecified | ||
E27042 | Medicare UPIN | ||
MD | KZ41 / 646429-01 | Other | BC / BS OF MD |
MD | S186 / S186 | Other | BLUECHOICE |