Provider Demographics
NPI:1720309941
Name:GLOVER, MARY HOLLINGSWORTH BOWDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:HOLLINGSWORTH BOWDRE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:HOLLINGSWORTH
Other - Last Name:BOWDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3001 NEWCASTLE LOOP
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4502
Mailing Address - Country:US
Mailing Address - Phone:843-215-1100
Mailing Address - Fax:843-215-1211
Practice Address - Street 1:3001 NEWCASTLE LOOP
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4502
Practice Address - Country:US
Practice Address - Phone:843-215-1100
Practice Address - Fax:843-215-1211
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36712207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12717246OtherCAQH
0233298OtherCIGNA
0233298OtherCIGNA