Provider Demographics
NPI:1154379022
Name:GOWER, ELIZABETH J (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:GOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 LYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6017
Mailing Address - Country:US
Mailing Address - Phone:757-306-8940
Mailing Address - Fax:
Practice Address - Street 1:100 CONSTITUTION DR
Practice Address - Street 2:SUITE 217
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6799
Practice Address - Country:US
Practice Address - Phone:757-499-7442
Practice Address - Fax:757-490-3638
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
105552OtherANTHEM BC/BS
36465OtherOPTIMA
VA1154379022Medicaid