Provider Demographics
NPI:1982787834
Name:BOWEN ERICKSEN, MARCIA E (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:E
Last Name:BOWEN ERICKSEN
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 1:86116 MARENGO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:718-465-3622
Mailing Address - Fax:718-465-2127
Practice Address - Street 1:23201 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11422
Practice Address - Country:US
Practice Address - Phone:718-525-9655
Practice Address - Fax:718-525-9656
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2014801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G77766Medicare UPIN