MEDICARE: TIMOTHY FOWLER CHRISTIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	157777	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689744708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY FOWLER CHRISTIAN MD

Provider Business Mailing Address
First Line	:	35 SHADOW LN
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-2524
Country	:	US
Telephone Number	:	802-999-5839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	718-918-3513
Fax Number	:	718-975-6594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	09/01/2020

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