Provider Demographics
NPI:1235117169
Name:MCGOWAN, ARCHIE R (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHIE
Middle Name:R
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 986520 DEPARTMENT 250
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6520
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-1439
Practice Address - Street 1:175 FORE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2779
Practice Address - Country:US
Practice Address - Phone:207-879-3000
Practice Address - Fax:207-777-1439
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1544922085N0700X, 2085R0204X
NH117842085N0700X, 2085R0202X
MEMD274932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH24246099Medicaid
NHRE7218Medicare PIN
H62331Medicare UPIN