Provider Demographics
NPI:1851399117
Name:BOWER, PETER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:BOWER
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 1:1415 ROLKIN CT STE 301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3643
Mailing Address - Country:US
Mailing Address - Phone:434-964-0159
Mailing Address - Fax:434-978-1667
Practice Address - Street 1:1415 ROLKIN CT STE 301
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3643
Practice Address - Country:US
Practice Address - Phone:434-964-0159
Practice Address - Fax:434-978-1667
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051008208VP0000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080161381OtherRR
VA080007333Medicare ID - Type Unspecified
VAA50158Medicare UPIN