Wayne Richard Bowerman, PA-C
Individual provider Active NPI Physician Assistant · Middle River, MD
NPI 1053786624 · NPPES record last updated Dec 8, 2015
Key facts
- NPI
- 1053786624
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- C06016 (MD)
- Practice address
- 7 Mariners Walk Way
Middle River, MD 21220-5609 - Phone
- (443) 462-7116
- NPI assigned
- Dec 8, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160310001769 | MD | Practitioner - Physician Assistant | 4688970064 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sinai Hospital of Baltimore Inc | Current |
Accepting new patients | |
| Sinai Hospital of Baltimore, Inc. | Current |
Accepting new patients |
Locations
2401 W Belvedere Ave
Ste 42
Baltimore, MD 21215
Phone (410) 601-5843
2435 W Belvedere Ave
Ste 4
Baltimore, MD 21215
Phone (410) 601-5547
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C06016 | MD | Yes |
Addresses
Primary practice location
7 Mariners Walk Way
Middle River, MD 21220-5609
Mailing address
7 Mariners Walk Way
Middle River, MD 21220-5609
Phone (443) 462-7116
Other providers in Middle River, MD
- Beulahco Home Care Services
- Bibi Adult Primary Care, Limited Liability Company
- Steven Robert Bode
- Dominique Bonds
- Chante Bonner
- Camille Brooks
- Katrina Burton
- Shari Cain
- Kimberly Chase
- Leonid Chernyakhovsky
All providers in Middle River, MD · Physician Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.