Provider Demographics
NPI:1649231606
Name:BOWMAN, CHRISTOPHER EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EDWARD
Last Name:BOWMAN
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 1:1100 GROSSCUP AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3120
Mailing Address - Country:US
Mailing Address - Phone:304-768-8811
Mailing Address - Fax:304-768-4072
Practice Address - Street 1:3752 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9705
Practice Address - Country:US
Practice Address - Phone:304-757-3131
Practice Address - Fax:304-760-6173
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19283208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9156433OtherGROUP MEDICARE
WV4132981Medicare PIN
WV9156433OtherGROUP MEDICARE