Provider Demographics
NPI:1235525957
Name:DOWDEN, CARL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:WAYNE
Last Name:DOWDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:DOWDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:4040 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6438
Practice Address - Country:US
Practice Address - Phone:540-772-4453
Practice Address - Fax:540-772-4717
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52895208000000X
390200000X
VA0101275442208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52895OtherMEDICAL LICENSE