Provider Demographics
NPI:1801991658
Name:MCGOWAN, JOHN R (PH D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1105
Mailing Address - Country:US
Mailing Address - Phone:856-222-0783
Mailing Address - Fax:856-222-9714
Practice Address - Street 1:3829 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1105
Practice Address - Country:US
Practice Address - Phone:856-222-0783
Practice Address - Fax:856-222-9714
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100302200103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7791402Medicaid
NJ223386618OtherTAX ID NUMBER
NJ7791402Medicaid