Provider Demographics
NPI:1679581672
Name:BOWEN, JOSEPH J (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1075 CHASE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2948
Mailing Address - Country:US
Mailing Address - Phone:203-591-3077
Mailing Address - Fax:203-591-3074
Practice Address - Street 1:1075 CHASE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2948
Practice Address - Country:US
Practice Address - Phone:203-591-3077
Practice Address - Fax:203-591-3074
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025522207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010025522CT03OtherANTHEM BCBS
061239390003OtherCIGNA
2457525OtherAETNA
181548OtherWELLCARE
NHS010OtherOXFORD
3521911693001OtherEMPLOYER ID
025522OtherCONNECTICARE
00125522302OtherWORKER'S COMP
2V2914OtherHEALTH NET
025522OtherCONNECTICARE