Healthcare Provider Details

I. General information

NPI: 1417901752
Provider Name (Legal Business Name): SANDRA FOWLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ANTRIM COMMONS DR
GREENCASTLE PA
17225-1623
US

IV. Provider business mailing address

785 5TH AVE STE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-597-5553
  • Fax: 717-597-5522
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-709-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0050738
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: