Provider Demographics
NPI:1154888048
Name:BOWIE STATE UNIVERSITY
Entity type:Organization
Organization Name:BOWIE STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT STUDENT AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:301-860-3390
Mailing Address - Street 1:14000 JERICHO PARK ROAD
Mailing Address - Street 2:HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:301-860-4170
Mailing Address - Fax:601-860-4179
Practice Address - Street 1:14000 JERICHO PARK ROAD
Practice Address - Street 2:HENRY WISE WELLNESS CENTER, CMRC, LOWER LEVEL
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-860-4170
Practice Address - Fax:601-860-4179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOWIE STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty