Provider Demographics
NPI:1881874311
Name:BOWEN, LAWRENCE P (M D)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:BOWEN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PLAIN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3240
Mailing Address - Country:US
Mailing Address - Phone:401-331-4140
Mailing Address - Fax:401-331-0410
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-331-4140
Practice Address - Fax:401-331-0410
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI05305208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000759Medicaid
MA30202009OtherMASS. BCBS
RI300042OtherBLUE CHIP
RI4000248OtherNEIGHBORHOOD HEALTH
MA30202009OtherMASS. BCBS