Provider Demographics
NPI:1538161450
Name:MCDOWELL, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:603-752-1709
Practice Address - Street 1:2 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1502
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:603-466-2953
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5240207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204172Medicaid
NH5240OtherSTATE LICENSE #
NHP00186035OtherRAILROAD MEDICARE
NH5317585002OtherCIGNA HEALTHCARE
5830418OtherAETNA GROUP
NH0104851YPNH02OtherANTHEM BC/BS
AM6246816OtherFEDERAL DEA#
NHP00186035OtherRAILROAD MEDICARE
NH5240OtherSTATE LICENSE #
D43238Medicare UPIN
NHSX3254Medicare PIN
NH5317585002OtherCIGNA HEALTHCARE
NHNH011001Medicare PIN
AM6246816OtherFEDERAL DEA#