Provider Demographics
NPI:1962659557
Name:BOWERY, ELIZABETH CUSTODIO
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CUSTODIO
Last Name:BOWERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W PRATT ST
Mailing Address - Street 2:THIRD FLOOR ROOM 357
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-7037
Mailing Address - Fax:410-328-3311
Practice Address - Street 1:611 S CHARLES ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3801
Practice Address - Country:US
Practice Address - Phone:410-328-2293
Practice Address - Fax:410-328-5895
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program