Provider Demographics
NPI:1699724278
Name:BOWERS, TERESA ANNA (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNA
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 520
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4247
Practice Address - Country:US
Practice Address - Phone:864-455-9033
Practice Address - Fax:864-455-6559
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21411207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214119Medicaid
SC57-6007863110OtherBCBS OF SC
SC57-6007863114OtherBLUE CHOICE OF SC
SC6966148OtherCIGNA
SC110247975OtherRR MEDICARE
SC4532720OtherAETNA
SCF936747951Medicare PIN
SC4532720OtherAETNA
SC214119Medicaid