Healthcare Provider Details

I. General information

NPI: 1235525957
Provider Name (Legal Business Name): CARL WAYNE DOWDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. WAYNE DOWDEN

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 POSTAL DR
ROANOKE VA
24018-6438
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-4453
  • Fax: 540-772-4717
Mailing address:
  • Phone: 540-224-5715
  • Fax: 540-224-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52895
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101275442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: