Provider Demographics
NPI:1700810603
Name:BOWMAN, RICHARD G II (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:BOWMAN
Suffix:II
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 1:100 PEYTON WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8545
Mailing Address - Country:US
Mailing Address - Phone:904-638-6147
Mailing Address - Fax:904-638-6147
Practice Address - Street 1:200 ORTHOPEDIC WAY
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1240
Practice Address - Country:US
Practice Address - Phone:681-214-5399
Practice Address - Fax:304-241-5167
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20316208VP0014X, 2081P2900X
TNMD00000314202081P2900X, 208VP0014X
WVWV20316208VP0014X
KY36469208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVH398OtherMEDICARE GROUP
WV1807399000Medicaid
WV0207026000OtherMEDICAID GROUP
WV1807399000Medicaid
WV9333201OtherMEDICARE GROUP
WVCI5175OtherRR MEDICARE
WVH40722Medicare UPIN
WV55075562100OtherWORKERS COMPENSATION
WV250012655OtherRR MEDICARE
WV9296571Medicare PIN
WV3120416OtherMAMSI OPTIMUM CHOICE
WV1807399000Medicaid
WV2154791OtherUHC
WV550755621OtherTRICARE GROUP
WV5544650001Medicare NSC