Provider Demographics
NPI:1316940588
Name:FOWLER, PAUL BYRON (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BYRON
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 FRANKLIN SQUARE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-5333
Mailing Address - Country:US
Mailing Address - Phone:410-682-6800
Mailing Address - Fax:410-682-2783
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-532-5258
Practice Address - Fax:410-532-5276
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO44314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD48452Medicaid
MDF42807Medicare UPIN
MDK328JE23Medicare PIN