Provider Demographics
NPI:1639245244
Name:MCGOWAN, HEATHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:115 MAIN STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2911
Mailing Address - Country:US
Mailing Address - Phone:914-771-7070
Mailing Address - Fax:914-771-7073
Practice Address - Street 1:115 MAIN STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2911
Practice Address - Country:US
Practice Address - Phone:914-771-7070
Practice Address - Fax:914-771-7073
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY216946208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02270928Medicaid