Provider Demographics
NPI:1669462636
Name:DOW, W. ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:ALBERT
Last Name:DOW
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 1:455 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-1545
Mailing Address - Country:US
Mailing Address - Phone:609-387-0110
Mailing Address - Fax:609-387-8223
Practice Address - Street 1:455 BROAD ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:NJ
Practice Address - Zip Code:08010-1545
Practice Address - Country:US
Practice Address - Phone:609-387-0110
Practice Address - Fax:609-387-8223
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02764000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2150603Medicaid
NJE51392Medicare UPIN
NJ2150603Medicaid