Provider Demographics
NPI:1134194939
Name:BOWLIN, DENEEN (MD)
Entity type:Individual
Prefix:
First Name:DENEEN
Middle Name:
Last Name:BOWLIN
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 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:410-247-5602
Mailing Address - Fax:410-242-1756
Practice Address - Street 1:711 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3632
Practice Address - Country:US
Practice Address - Phone:410-247-5602
Practice Address - Fax:410-242-1756
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD101021200Medicaid
MD52859802OtherBCBS
T016-0037OtherBCBS-DC
0943ER-528598-04OtherCAREFIRST BCBS OF MD
MD008203100Medicaid
0404845OtherEVERCARE
093NER-528598-02OtherCAREFIRST BCBS OF MD
MD008203100Medicaid
MDG051Medicare PIN
0404845OtherEVERCARE