Provider Demographics
NPI:1316114994
Name:SPOERRI-BOWMAN, REBECCA ANNE (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:SPOERRI-BOWMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SPOERRI-BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:955 MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4303
Mailing Address - Country:US
Mailing Address - Phone:781-435-8004
Mailing Address - Fax:781-205-2003
Practice Address - Street 1:955 MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-4303
Practice Address - Country:US
Practice Address - Phone:781-435-8004
Practice Address - Fax:781-205-2003
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA122620Medicaid