Healthcare Provider Details

I. General information

NPI: 1043212327
Provider Name (Legal Business Name): MELISSA H FOWLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W 25TH ST
ERIE PA
16544-0002
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-5000
  • Fax: 814-456-4542
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD0421058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: