Provider Demographics
NPI:1518253087
Name:BOWERS, JOSEPH A
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 HACK WILSON WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4384
Mailing Address - Country:US
Mailing Address - Phone:304-596-2361
Mailing Address - Fax:304-267-2577
Practice Address - Street 1:176 HACK WILSON WAY
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4384
Practice Address - Country:US
Practice Address - Phone:304-596-2361
Practice Address - Fax:304-267-2577
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV791086332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001979878OtherBLUE CROSS BLUE SHIELD
WV3810009126Medicaid
WV5870820001Medicare NSC