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General NPI Number Information
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NPI Number | 1760588263
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Entity Type | Individual
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Provider Name | WILLIAM C FOWLKES MD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 67 THOMAS JOHNSON DR SUITE 4
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City | FREDERICK
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State | MD
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Zip | 21702-4863
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Country | US
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Telephone | 301-607-0444
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Fax | 301-831-4495
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Provider Business Mailing Address
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Address Line | 4110 ASPEN HILL RD SUITE 200
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City | ROCKVILLE
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State | MD
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Zip | 20853-2853
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Country | US
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Telephone | 301-438-5150
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Fax | 301-460-0199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D0067685
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | D0067685
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License Number State | MD
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