Basic Information
| Provider Information | |||||||||
| NPI: | 1023279171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A. M. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 WASHINGTON ST | ||||||||
| Address2: | BOX 311 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176364720 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 750 WASHINGTON ST | ||||||||
| Address2: | BOX 311 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176364720 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2008 | ||||||||
| LastUpdateDate: | 06/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 657 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.