Provider Demographics
NPI:1881466530
Name:GOWENS, MARIAH (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:GOWENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 FORTUNES RIDGE DR STE P
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6102
Mailing Address - Country:US
Mailing Address - Phone:919-391-7202
Mailing Address - Fax:
Practice Address - Street 1:5501 FORTUNES RIDGE DR STE P
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6102
Practice Address - Country:US
Practice Address - Phone:919-391-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001013734363AM0700X
NC0010-13734207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical