Provider Demographics
NPI:1548333487
Name:BOBOWICK, ALPHONSE ROGER (MD)
Entity type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:ROGER
Last Name:BOBOWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:ROGER
Other - Last Name:BOBWICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:134 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-757-8735
Mailing Address - Fax:203-757-8736
Practice Address - Street 1:134 GRANDVIEW AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-757-8735
Practice Address - Fax:203-757-8736
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0132902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83177Medicare UPIN