Provider Demographics
NPI:1548379795
Name:OWENS, MICHAEL D (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:OWENS
Suffix:
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 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-1365
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIRCILE
Practice Address - Street 2:NAVAL MEDICAL CENTER PORTSMOUTH
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007036207P00000X
VA0102201730207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA082480OtherBLUE CROSS BLUE SHIELD VA
213586807OtherTRICARE
251490OtherMAMSI/MDIPA
P00237810OtherMEDICARE RAILROAD
VA010181674Medicaid
3900570OtherOPTIMUM CHOICE
NC89067A7Medicaid
95343OtherOPTIMA
NC067T0OtherBLUE CROSS BLUE SHIELD NC
3900570OtherOPTIMUM CHOICE
008031T83Medicare ID - Type Unspecified