Healthcare Provider Details

I. General information

NPI: 1881510550
Provider Name (Legal Business Name): SARA L FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA LYNN SMITH

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VILLAGE SQ STE 168
BALTIMORE MD
21210-1602
US

IV. Provider business mailing address

1 VILLAGE SQ STE 168
BALTIMORE MD
21210-1602
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2134
  • Fax:
Mailing address:
  • Phone: 410-800-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR199552
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: