Provider Demographics
NPI:1013908763
Name:MCGOWAN, KATHLEEN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:STE. 400
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-261-1285
Mailing Address - Fax:614-262-1633
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:STE. 400
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-261-1285
Practice Address - Fax:614-262-1633
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045391M207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180001614OtherRAILROAD MEDICARE PROV #
OH0513457Medicaid
OH000000118279OtherANTHEM PIN
OH3110682522001OtherBCBS PROVIDER NUMBER
OH1846495OtherCIGNA PROVIDER NUMBER
OH31106825200OtherOHIO BWC PROV #
OH4071068OtherAETNA PROVIDER NUMBER
OH311068252-003OtherMEDICAL MUTUAL PROVIDER #
OH180001614OtherRAILROAD MEDICARE PROV #
OHMC0529472Medicare ID - Type Unspecified