Provider Demographics
NPI:1821192246
Name:DOWEN, MICHAEL DORGLAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DORGLAS
Last Name:DOWEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1402
Mailing Address - Country:US
Mailing Address - Phone:540-672-0474
Mailing Address - Fax:540-672-3029
Practice Address - Street 1:112 BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1402
Practice Address - Country:US
Practice Address - Phone:540-672-0474
Practice Address - Fax:540-672-3029
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA234051000OtherMAGELLAN
VA351326OtherMAMSI
VA7713681Medicaid
VA087619OtherSENTARA
VA112619OtherVALUE OPTIONS
VA460634OtherANTHEM
VA112619OtherVALUE OPTIONS