Basic Information
| Provider Information | |||||||||
| NPI: | 1538179098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWEN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 PERIMETER PARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9842154110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 S CAMERON ST | ||||||||
| Address2: | |||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272782505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197329311 | ||||||||
| FaxNumber: | 9197329315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2006-00425 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD40277 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5905626 | 05 | NC | MEDICAID | 144P5 | 01 | NC | BCBS | OTHER |