Provider Demographics
NPI:1902851926
Name:GOWANS, MELISSA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEAN
Last Name:GOWANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MOLLISON WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5805
Mailing Address - Country:US
Mailing Address - Phone:207-784-5782
Mailing Address - Fax:207-786-5756
Practice Address - Street 1:33 MOLLISON WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5805
Practice Address - Country:US
Practice Address - Phone:207-784-5782
Practice Address - Fax:207-786-5756
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC162CNOtherBCBSNC
NC5917112Medicaid
KS200386620BMedicaid
WYTL3125OtherWYOMING BOARD OF MEDICINE
NC2077245Medicare PIN
NC5917112Medicaid