Provider Demographics
NPI:1366522088
Name:BOWDEN, WILLIAM PATRICK (PA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1547 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9543
Mailing Address - Country:US
Mailing Address - Phone:518-479-4156
Mailing Address - Fax:
Practice Address - Street 1:1547 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9543
Practice Address - Country:US
Practice Address - Phone:518-479-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ48374Medicare UPIN
NYPA0981Medicare ID - Type Unspecified