Provider Demographics
NPI:1053372300
Name:BOWER, REBECCA W (PA-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:W
Last Name:BOWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CLAIRE
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 WASHINGTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5832
Mailing Address - Country:US
Mailing Address - Phone:410-876-0286
Mailing Address - Fax:410-876-0634
Practice Address - Street 1:532 BALTIMORE BLVD STE 211
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6128
Practice Address - Country:US
Practice Address - Phone:410-751-3840
Practice Address - Fax:410-751-3874
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002877363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKL09I870Medicare PIN
MDQ18239Medicare UPIN