Healthcare Provider Details

I. General information

NPI: 1497940282
Provider Name (Legal Business Name): BOWSER PODIATRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WILLOWCREST CIR
BALTIMORE MD
21209-3730
US

IV. Provider business mailing address

2001 WILLOWCREST CIR
BALTIMORE MD
21209-3730
US

V. Phone/Fax

Practice location:
  • Phone: 410-736-2241
  • Fax:
Mailing address:
  • Phone: 410-736-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01245
License Number StateMD

VIII. Authorized Official

Name: DR. LLOYD THOMAS BOWSER JR.
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 410-736-2241