Healthcare Provider Details

I. General information

NPI: 1013201672
Provider Name (Legal Business Name): JANINA FOWLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANINA HEYWOOD

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 HOSPITAL DR STE 130
DUBLIN OH
43016-9600
US

IV. Provider business mailing address

335 GLESSNER AVE RM 325
MANSFIELD OH
44903-2269
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-0300
  • Fax: 614-923-0400
Mailing address:
  • Phone: 419-520-2495
  • Fax: 419-520-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.123033
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: