Healthcare Provider Details

I. General information

NPI: 1053796268
Provider Name (Legal Business Name): BRIAN G. DOWLING DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VIRGINIA AVE
CUMBERLAND MD
21502-4551
US

IV. Provider business mailing address

600 VIRGINIA AVE
CUMBERLAND MD
21502-4551
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-7780
  • Fax: 301-777-7790
Mailing address:
  • Phone: 301-777-7780
  • Fax: 301-777-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01258
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01258
License Number StateMD

VIII. Authorized Official

Name: BRIAN G DOWLING
Title or Position: OWNER
Credential: D.P.M.
Phone: 301-777-7780