Healthcare Provider Details

I. General information

NPI: 1982695557
Provider Name (Legal Business Name): AMY SUSAN BINGHAM FOWLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 KILDAIRE RD SUITE 200
CHAPEL HILL NC
27516-4064
US

IV. Provider business mailing address

301 KILDAIRE RD SUITE 200
CHAPEL HILL NC
27516-4064
US

V. Phone/Fax

Practice location:
  • Phone: 919-967-0771
  • Fax: 919-967-9207
Mailing address:
  • Phone: 919-967-0771
  • Fax: 919-967-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9700553
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier11456
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS OF NC
# 2
Identifier8911456
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: