Provider Demographics
NPI:1053117218
Name:BOWMAN, ROSCOE T IV
Entity type:Individual
Prefix:
First Name:ROSCOE
Middle Name:T
Last Name:BOWMAN
Suffix:IV
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 HOLTZMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1633
Mailing Address - Country:US
Mailing Address - Phone:614-556-5107
Mailing Address - Fax:
Practice Address - Street 1:571 HOLTZMAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1633
Practice Address - Country:US
Practice Address - Phone:614-556-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator