Provider Demographics
NPI:1942204334
Name:BOWERS, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
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 1:380 SERPENTINE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3066
Mailing Address - Country:US
Mailing Address - Phone:864-560-7050
Mailing Address - Fax:864-560-7057
Practice Address - Street 1:380 SERPENTINE DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3066
Practice Address - Country:US
Practice Address - Phone:864-560-7050
Practice Address - Fax:864-560-7057
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21412174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89063Y9Medicaid
SCT55570Medicaid
NC89063Y9Medicaid
SCF58337Medicare UPIN
SCT55570Medicaid