Provider Demographics
NPI:1033370911
Name:GOWEN, LAURA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:GOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:SEIBOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING TWO, SUITE 307
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-0500
Mailing Address - Fax:
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING TWO, SUITE 105
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451957208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery