MEDICARE: PAUL BYRON FOWLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	DOO44314	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316940588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BYRON FOWLER M.D.

Provider Business Mailing Address
First Line	:	9105 FRANKLIN SQUARE DR
Second Line	:	STE 100
City	:	BALTIMORE
State	:	MD
Zip	:	21237-5333
Country	:	US
Telephone Number	:	410-682-6800
Fax Number	:	410-682-2783

Provider Business Practice Location Address
First Line	:	5601 LOCH RAVEN BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21239-2905
Country	:	US
Telephone Number	:	410-532-5258
Fax Number	:	410-532-5276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/27/2010

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