Provider Demographics
NPI:1194716308
Name:BOWLING, DAVID MARSH (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARSH
Last Name:BOWLING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-874-1965
Mailing Address - Fax:781-874-1967
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-874-1965
Practice Address - Fax:781-874-1967
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72354207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA072354OtherTUFTS HEALTH PLAN
F78500Medicare UPIN
MAJ30450OtherBCBS MA
MAJ30450Medicare ID - Type Unspecified
MA3125939Medicaid