Provider Demographics
NPI:1518900026
Name:FOWLER, PAUL RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18313 LEEDSTOWN WAY
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3135
Mailing Address - Country:US
Mailing Address - Phone:301-570-5409
Mailing Address - Fax:
Practice Address - Street 1:18313 LEEDSTOWN WAY
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3135
Practice Address - Country:US
Practice Address - Phone:301-570-5409
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00572172083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine