Provider Demographics
NPI:1154396703
Name:BOWERSOX, NATALIE A (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:A
Last Name:BOWERSOX
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 1:3574 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3618
Mailing Address - Country:US
Mailing Address - Phone:330-225-8886
Mailing Address - Fax:440-878-2620
Practice Address - Street 1:3574 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3618
Practice Address - Country:US
Practice Address - Phone:330-225-8886
Practice Address - Fax:440-878-2620
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2365B207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2425790Medicaid
OH2425790Medicaid
H85642Medicare UPIN