Healthcare Provider Details

I. General information

NPI: 1316940588
Provider Name (Legal Business Name): PAUL BYRON FOWLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

9105 FRANKLIN SQUARE DR STE 100
BALTIMORE MD
21237-5333
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-5258
  • Fax: 410-532-5276
Mailing address:
  • Phone: 410-682-6800
  • Fax: 410-682-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDOO44314
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: