Provider Demographics
NPI:1174532188
Name:GOWESKY, BRENDA ANNE
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:ANNE
Last Name:GOWESKY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:ANNE
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-7000
Practice Address - Fax:207-973-5042
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17575207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000299601Medicare PIN