Basic Information
| Provider Information | |||||||||
| NPI: | 1104813377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOWA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 KENSINGTON AVE | ||||||||
| Address2: | GROVE HILL MEDICAL CENTER | ||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060513916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607470730 | ||||||||
| FaxNumber: | 8607472028 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 EAST ST | ||||||||
| Address2: | GROVE HILL MEDICAL CENTER | ||||||||
| City: | PLAINVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060622913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607470730 | ||||||||
| FaxNumber: | 8607472028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207V00000X | 029591 | CT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 004196095 | 05 | CT | MEDICAID | 1255448144 | 01 | CT | GHMC GROUP NPI ID | OTHER | 482005 | 01 | CT | AETNA | OTHER | P369836 | 01 | CT | OXFORD | OTHER | 001295915 | 05 | CT | MEDICAID | 160031240 | 01 | CT | RAIL ROAD MEDICARE | OTHER | 01029591 | 01 | CT | CIGNA | OTHER | 010029591CT01 | 01 | CT | BCBS & BCFP ID | OTHER | 2959101 | 01 | CT | CONNECTICARE | OTHER | 368793 | 01 | CT | WELLCARE MEDICARE | OTHER | 060027 | 01 | CT | HEALTH NET | OTHER |