Provider Demographics
NPI:1659373926
Name:BOWERS, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BOWERS
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 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:STE 518
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-731-9067
Mailing Address - Fax:973-731-0651
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:STE 518
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-731-9067
Practice Address - Fax:973-731-0651
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03846900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0791898000OtherAMERIHEALTH ID #
NJ8283303Medicaid
NJ10988OtherAMERIGROUP / AMERICAID ID
NJ4093998OtherAETNA PPO ID #
NJ0041953OtherAETNA HMO ID #
NJ0K7075OtherHEALTHNET ID #
NJEP177OtherOXFORD ID #
NJ0056541OtherGHI PPO ID #
NJ1009105OtherHORIZON MERCY ID #
NJ2489503Medicaid
NJ47A221OtherEMPIRE BC/BS OF NY ID #
NJF13858Medicare UPIN
NJ538131Medicare ID - Type UnspecifiedMEDICARE ID #