Provider Demographics
NPI:1871552265
Name:BOWER, ELIZABETH S (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:BOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LONGSTONE LN STE 106
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1532
Mailing Address - Country:US
Mailing Address - Phone:410-480-1895
Mailing Address - Fax:410-480-4955
Practice Address - Street 1:2400 LONGSTONE LN STE 106
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1532
Practice Address - Country:US
Practice Address - Phone:410-480-1895
Practice Address - Fax:410-480-4955
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD719201100Medicaid
MD0015OtherCAREFIRST-DC
MD841247-03OtherCAREFIRST-MD
MD841247-03OtherCAREFIRST-MD
H07893Medicare UPIN