Provider Demographics
NPI:1619909728
Name:BOWLES, RICHARD BOXLEY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BOXLEY
Last Name:BOWLES
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 1:13890 BRADDOCK RD
Mailing Address - Street 2:201
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2435
Mailing Address - Country:US
Mailing Address - Phone:703-631-0331
Mailing Address - Fax:703-631-2573
Practice Address - Street 1:13890 BRADDOCK RD
Practice Address - Street 2:201
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:703-631-0331
Practice Address - Fax:703-631-2573
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-0962166OtherTAX ID #
VA54-0962166OtherTAX ID #
VA1817Medicare ID - Type Unspecified