MEDICARE: EMILIE JANE FOWLER

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	207N00000X	Dermatology Physician	327121	NY

General Provider Information

NPI Number	:	1861020935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIE JANE FOWLER

Provider Business Mailing Address
First Line	:	200 MEDICAL PLAZA SUITE 450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 E 88TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-2270
Country	:	US
Telephone Number	:	212-283-3000
Fax Number	:

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	07/09/2024

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Directions to “ EMILIE JANE FOWLER ” Practice Location

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