Basic Information
Provider Information
NPI: 1497744304
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STOWE
FirstName: BARRY
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 E MCBEE AVE FL 4
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296012842
CountryCode: US
TelephoneNumber: 7043775772
FaxNumber: 7043773389
Practice Location
Address1: 67 CREEKSIDE PARK CT
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296154810
CountryCode: US
TelephoneNumber: 7043552372
FaxNumber: 7043556692
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 06/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LP3000X85616SCY Allopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
207L00000X200200811NCN Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
N0081105SC MEDICAID
89133NW05NC MEDICAID


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