Provider Demographics
NPI:1588688899
Name:BOWERS, TIMOTHY KEEFE SR (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KEEFE
Last Name:BOWERS
Suffix:SR
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:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-0948
Mailing Address - Country:US
Mailing Address - Phone:304-263-7591
Mailing Address - Fax:304-263-8318
Practice Address - Street 1:2008 PROFESSIONAL COURT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-263-7591
Practice Address - Fax:304-263-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11538207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008767001Medicaid
WV0082852000Medicaid
WV0008767001Medicaid
WVA72046Medicare UPIN