Individual
SHANE MATTHEW MCGOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7650 EAST PARHAM ROAD, SUITE 100, RICHMOND, VA 23294
(804) 288-3136
Mailing address
860 OMNI BLVD STE 101, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101266708
VA
207X00000X
Orthopaedic Surgery Physician
MT204834
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101266708
VIRGINIA BOARD OF MEDICINE
VA
01
—
MT204834
GRADUATE MEDICAL TRAINEE LICENSE
PA
Enumeration date
07/25/2013
Last updated
01/27/2022
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