Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 10002452A | IN |
NPI | 1366952699 |
---|---|
Provider Name | Mr. Seneca C Mcgowan |
First Address | Charlestown, IN 47111-9535 |
Second Address | Jeffersonville, IN 47130-6016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2017 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10002452A | STATE LICENSE (01) | IN |
300011189 | (05) | IN |
IN3604013 | MEDICARE PTAN (01) | IN |