Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 0401414597 | VA |
N | 213EG0000X | General Practice | 0401414597 | VA |
Y | 1223P0221X | Pediatric Dentist | 17217 | MD |
NPI | 1083013866 |
---|---|
Provider Name | Christina Bowman |
First Address | Port Deposit, MD 21904-1520 |
Second Address | Port Deposit, MD 21904-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 22/01/2020 |