Provider Demographics
NPI:1417906231
Name:TOWLE, DAVID W (DO02/15/1955)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:TOWLE
Suffix:
Gender:M
Credentials:DO02/15/1955
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9367
Mailing Address - Country:US
Mailing Address - Phone:315-779-5070
Mailing Address - Fax:315-779-5084
Practice Address - Street 1:272 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9031
Practice Address - Country:US
Practice Address - Phone:740-779-4100
Practice Address - Fax:740-779-7050
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354316Medicaid
OH3131953Medicaid
OH3131953Medicaid
NY00354316Medicaid