Healthcare Provider Details

I. General information

NPI: 1417906231
Provider Name (Legal Business Name): DAVID W TOWLE D.O.02/15/1955
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

1575 WASHINGTON ST
WATERTOWN NY
13601-9367
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4100
  • Fax: 740-779-7050
Mailing address:
  • Phone: 315-779-5070
  • Fax: 315-779-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.010097
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: