Provider Demographics
NPI:1619944626
Name:BOWERS, JACQUELINE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BOWERS
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 1:5401 OLD YORK ROAD
Mailing Address - Street 2:EINSTEIN INTERNAL MEDICINE ASSOCIATES/HOSPITALISTS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-456-6940
Mailing Address - Fax:215-455-1933
Practice Address - Street 1:5401 OLD YORK ROAD
Practice Address - Street 2:EINSTEIN INTERNAL MEDICINE ASSOCIATES/HOSPITALISTS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-6940
Practice Address - Fax:215-455-1933
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072341L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018628610002Medicaid
H52423Medicare UPIN
PA0018628610002Medicaid