Provider Demographics
NPI:1588670699
Name:BOWENS, WILLIAM CLEMENT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLEMENT
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 1:161 STANDARD BRED WAY
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-7919
Mailing Address - Country:US
Mailing Address - Phone:252-338-1100
Mailing Address - Fax:252-338-1103
Practice Address - Street 1:1825 W CITY DR
Practice Address - Street 2:SUITE F
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9675
Practice Address - Country:US
Practice Address - Phone:252-338-1100
Practice Address - Fax:252-338-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131967174400000X
NC257752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202735COtherPTAN
NC5907217Medicaid
NC1588670699OtherNPI
NC5907217Medicaid