Provider Demographics
NPI:1558012583
Name:BOWERING, CAROLYN E
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:E
Last Name:BOWERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 GRANDADS LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5565
Mailing Address - Country:US
Mailing Address - Phone:304-696-6035
Mailing Address - Fax:
Practice Address - Street 1:33 MAGOTHY BEACH RD STE 102-103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4413
Practice Address - Country:US
Practice Address - Phone:480-939-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical